Healthcare Provider Details

I. General information

NPI: 1134462906
Provider Name (Legal Business Name): DR. MATTHEW RICHARD MORALLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2013
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 VONDERBURG DR
BRANDON FL
33511
US

IV. Provider business mailing address

6748 GALL BLVD
ZEPHYRHILLS FL
33542-2511
US

V. Phone/Fax

Practice location:
  • Phone: 813-684-2663
  • Fax: 813-441-7161
Mailing address:
  • Phone: 813-467-4270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME141990
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: