Provider Demographics
NPI:1730363896
Name:LUIS E MORALES MDPA FAMILY PRACTICE
Entity type:Organization
Organization Name:LUIS E MORALES MDPA FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEVAR
Authorized Official - Middle Name:J
Authorized Official - Last Name:TOMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-682-7272
Mailing Address - Street 1:809 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2008
Mailing Address - Country:US
Mailing Address - Phone:407-682-7272
Mailing Address - Fax:407-682-7274
Practice Address - Street 1:809 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2008
Practice Address - Country:US
Practice Address - Phone:407-682-7272
Practice Address - Fax:407-682-7274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLME44936305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79955AMedicare PIN