Healthcare Provider Details

I. General information

NPI: 1427057231
Provider Name (Legal Business Name): ROBERTO A. MORALEDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 7TH ST NE
DEVILS LAKE ND
58301-2719
US

IV. Provider business mailing address

PO BOX 1100
DEVILS LAKE ND
58301-1100
US

V. Phone/Fax

Practice location:
  • Phone: 701-662-2157
  • Fax: 701-662-4116
Mailing address:
  • Phone: 701-662-2157
  • Fax: 701-662-4116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number7501
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier18843
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: