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: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 LAKELAND HILLS BLVD
LAKELAND FL
33805-3065
US

IV. Provider business mailing address

501 KNIGHTS RUN AVE APT 2203
TAMPA FL
33602-5947
US

V. Phone/Fax

Practice location:
  • Phone: 863-680-7000
  • Fax: 866-264-8519
Mailing address:
  • Phone: 908-489-2544
  • 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: