Healthcare Provider Details

I. General information

NPI: 1508193541
Provider Name (Legal Business Name): FERNANDO IVAN MORALES MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2009
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6755 GALL BLVD
ZEPHYRHILLS FL
33542-2522
US

IV. Provider business mailing address

6755 GALL BLVD
ZEPHYRHILLS FL
33542-2522
US

V. Phone/Fax

Practice location:
  • Phone: 813-782-4439
  • Fax: 813-782-4317
Mailing address:
  • Phone: 813-782-4439
  • Fax: 813-782-4317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberME0044937
License Number StateFL

VIII. Authorized Official

Name: DR. FERNANDO IVAN MORALES
Title or Position: MD PA
Credential: MD PA
Phone: 813-782-4439