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NPI Code Detail

MEDICARE: JOSE DAVID MORENOVELEZ PA-C

MEDICARE: JOSE DAVID MORENOVELEZ PA-C
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 Assistant0010-14943NC
2171000000XMilitary Health Care Provider

General Provider Information

NPI Number : 1962195594
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSE DAVID MORENOVELEZ PA-C
Provider Business Mailing Address
First Line : 2817 ROCK MERRITT AVE
Second Line :
City : FORT BRAGG
State : NC
Zip : 28310-0001
Country : US
Telephone Number : 910-907-8922
Fax Number : 910-907-6069
Provider Business Practice Location Address
First Line : 2817 ROCK MERRITT AVE
Second Line :
City : FORT BRAGG
State : NC
Zip : 28310-0001
Country : US
Telephone Number : 910-907-8922
Fax Number : 910-907-6069
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2023
Last Update Date : 05/25/2026

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