Provider Demographics
NPI:1003903709
Name:PEDRO J MORALES MD & TIM P CARLSON MD PA
Entity Type:Organization
Organization Name:PEDRO J MORALES MD & TIM P CARLSON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-327-9667
Mailing Address - Street 1:2191 9TH AVE NO
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713
Mailing Address - Country:US
Mailing Address - Phone:727-327-9667
Mailing Address - Fax:727-321-1655
Practice Address - Street 1:2191 9TH AVE NO
Practice Address - Street 2:SUITE 220
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713
Practice Address - Country:US
Practice Address - Phone:727-327-9667
Practice Address - Fax:727-321-1655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89 730207Q00000X
FLME 41704207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6683Medicare ID - Type Unspecified