1134170657 NPI number — DR. J MARK MORALES M.D.

Table of content: DR. J MARK MORALES M.D. (NPI 1134170657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134170657 NPI number — DR. J MARK MORALES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORALES
Provider First Name:
J
Provider Middle Name:
MARK
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134170657
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78463-0104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-854-0201
Provider Business Mailing Address Fax Number:
361-855-7572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1224 3RD ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78404-2354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-854-0201
Provider Business Practice Location Address Fax Number:
361-855-7572
Provider Enumeration Date:
05/12/2006

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: 208G00000X , with the licence number:  J54178 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 141578801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".