Healthcare Provider Details

I. General information

NPI: 1063689651
Provider Name (Legal Business Name): ROBERTO ANTONIO MORAN-BOJORQUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MERCY WAY
JOPLIN MO
64804-4524
US

IV. Provider business mailing address

100 MERCY WAY
JOPLIN MO
64804-4524
US

V. Phone/Fax

Practice location:
  • Phone: 417-556-2300
  • Fax: 417-556-3625
Mailing address:
  • Phone: 417-556-2300
  • Fax: 417-556-3625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2009016964
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2009016964
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: