Healthcare Provider Details

I. General information

NPI: 1225168784
Provider Name (Legal Business Name): J. MARK MORALES, M.D., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 3RD ST STE 1
CORPUS CHRISTI TX
78404-2354
US

IV. Provider business mailing address

PO BOX 30104
CORPUS CHRISTI TX
78463-0104
US

V. Phone/Fax

Practice location:
  • Phone: 361-854-0201
  • Fax: 361-855-7572
Mailing address:
  • Phone: 361-854-0201
  • Fax: 361-855-7572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberJ5418
License Number StateTX

VIII. Authorized Official

Name: MARTHA A GARCIA
Title or Position: PRACTICE MANAGER
Credential:
Phone: 361-854-0201