Healthcare Provider Details

I. General information

NPI: 1336136696
Provider Name (Legal Business Name): SANTIAGO MORALES JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34650 US HIGHWAY 19 N STE 104
PALM HARBOR FL
34684-2155
US

IV. Provider business mailing address

PO BOX 850001, DEPT 8340
ORLANDO FL
32885-0001
US

V. Phone/Fax

Practice location:
  • Phone: 727-233-4895
  • Fax: 727-400-4712
Mailing address:
  • Phone: 813-536-7277
  • Fax: 855-830-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME64207
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: