1013170513 NPI number — DR. CR JEANNETTE MORALES MD

Table of content: DR. CR JEANNETTE MORALES MD (NPI 1013170513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013170513 NPI number — DR. CR JEANNETTE MORALES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORALES
Provider First Name:
CR
Provider Middle Name:
JEANNETTE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORALES DUCRET
Provider Other First Name:
CR
Provider Other Middle Name:
JEANNETTE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1013170513
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 N DIXIE HIGHWAY
Provider Second Line Business Mailing Address:
SUITE 308
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33401-2717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-236-1711
Provider Business Mailing Address Fax Number:
561-736-9807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 N DIXIE HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33401-2717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-236-1711
Provider Business Practice Location Address Fax Number:
561-736-9807
Provider Enumeration Date:
07/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZD0900X , with the licence number:  ME0069744 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 008184100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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