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General NPI Number Information
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NPI Number | 1992735724
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Entity Type | Individual
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Provider Name | HENRY R MORA M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 09/01/2015
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Provider Practice Location Address
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Address Line | 18404 N TATUM BLVD STE. 101
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City | PHOENIX
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State | AZ
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Zip | 85032-1510
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Country | US
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Telephone | 602-992-1900
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Fax | 602-485-7450
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Provider Business Mailing Address
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Address Line | 18185 N. 83RD AVE BLDG D STE. 107
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City | PHOENIX
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State | AZ
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Zip | 85308-0520
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Country | US
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Telephone | 623-583-0306
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Fax | 623-583-1349
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 26554
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License Number State | AZ
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