MEDICARE: ELBA MORA MD

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
1	208D00000X	General Practice Physician	ME56855	FL

General Provider Information

NPI Number	:	1710922133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELBA MORA MD

Provider Business Mailing Address
First Line	:	1840 W 49TH ST
Second Line	:	SUITE 516
City	:	MIAMI
State	:	FL
Zip	:	33012-2942
Country	:	US
Telephone Number	:	305-556-1998
Fax Number	:	305-558-9812

Provider Business Practice Location Address
First Line	:	1840 W 49TH ST
Second Line	:	SUITE 516
City	:	MIAMI
State	:	FL
Zip	:	33012-2942
Country	:	US
Telephone Number	:	305-556-1998
Fax Number	:	305-558-9812

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	10/17/2011

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