Healthcare Provider Details

I. General information

NPI: 1750369948
Provider Name (Legal Business Name): ISIDOROS JAMES MORAITIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3890 TAMPA RD SUITE 406
PALM HARBOR FL
34684-3676
US

IV. Provider business mailing address

3890 TAMPA RD SUITE 406
PALM HARBOR FL
34684-3676
US

V. Phone/Fax

Practice location:
  • Phone: 727-773-9796
  • Fax: 727-773-9429
Mailing address:
  • Phone: 727-773-9796
  • Fax: 727-773-9429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME86072
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: