Healthcare Provider Details

I. General information

NPI: 1053458331
Provider Name (Legal Business Name): ROLANDO MORALES JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 06/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12727 KIMBERLEY LN SUITE 300
HOUSTON TX
77024-4047
US

IV. Provider business mailing address

12727 KIMBERLEY LN SUITE 300
HOUSTON TX
77024-4047
US

V. Phone/Fax

Practice location:
  • Phone: 713-799-9999
  • Fax: 713-722-8998
Mailing address:
  • Phone: 713-799-9999
  • Fax: 713-722-8998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberBP10029129
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL-2154
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberN9390
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: