Healthcare Provider Details

I. General information

NPI: 1619321924
Provider Name (Legal Business Name): FERNANDO MORAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 BROWN ST
EL PASO TX
79902-4724
US

IV. Provider business mailing address

11989 PELLICANO DR STE C
EL PASO TX
79936-6288
US

V. Phone/Fax

Practice location:
  • Phone: 915-544-4500
  • Fax:
Mailing address:
  • Phone: 915-857-0700
  • Fax: 915-857-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBP10055736
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberT5992
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberT5992
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: