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NPI Code Detail

MEDICARE: MORA PROFESSIONAL SERVICES INC

MEDICARE: MORA PROFESSIONAL SERVICES INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA9100684FL

General Provider Information

NPI Number : 1255618682
Entity Type Code : Organization
Provider Name (Legal Business Name) : MORA PROFESSIONAL SERVICES INC
Provider Business Mailing Address
First Line : 12451 MCGREGOR PALMS DR
Second Line :
City : FORT MYERS
State : FL
Zip : 33908-3055
Country : US
Telephone Number : 239-292-9314
Fax Number :
Provider Business Practice Location Address
First Line : 12451 MCGREGOR PALMS DR
Second Line :
City : FORT MYERS
State : FL
Zip : 33908-3055
Country : US
Telephone Number : 239-292-9314
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : PATRICK G MORA
Credential : PA-C
Telephone Number : 239-292-9314
Provider Enumeration Date : 11/14/2011
Last Update Date : 06/04/2012

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Directions to “MORA PROFESSIONAL SERVICES INC ” Practice Location

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