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General NPI Number Information
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NPI Number | 1255618682
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Entity Type | Organization
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Legal Business Name | MORA PROFESSIONAL SERVICES INC
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Dates
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Enumeration Date | 11/14/2011
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Last Update Date | 06/04/2012
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Provider Practice Location Address
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Address Line | 12451 MCGREGOR PALMS DR
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City | FORT MYERS
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State | FL
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Zip | 33908-3055
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Country | US
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Telephone | 239-292-9314
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Fax |
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Provider Business Mailing Address
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Address Line | 12451 MCGREGOR PALMS DR
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City | FORT MYERS
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State | FL
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Zip | 33908-3055
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Country | US
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Telephone | 239-292-9314
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PATRICK G MORA
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Credential | PA-C
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Telephone | 239-292-9314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9100684
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License Number State | FL
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