1093721193 NPI number — DR. MANUEL CASIMIRO MORALES M.D.

Table of content: DR. MANUEL CASIMIRO MORALES M.D. (NPI 1093721193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093721193 NPI number — DR. MANUEL CASIMIRO MORALES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORALES
Provider First Name:
MANUEL
Provider Middle Name:
CASIMIRO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORALES-CABRANES
Provider Other First Name:
MANUEL
Provider Other Middle Name:
CASIMIRO
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1093721193
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2110 LAKEVIEW LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KILLEEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76543-5574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-690-0830
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1901 S 1ST ST
Provider Second Line Business Practice Location Address:
TEMPLE VA MEDICAL CENTER
Provider Business Practice Location Address City Name:
TEMPLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76504-7451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-743-0441
Provider Business Practice Location Address Fax Number:
254-743-0178
Provider Enumeration Date:
07/31/2006

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: 207VG0400X , with the licence number:  3387 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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