Provider Demographics
NPI:1043238132
Name:MORA, MARIA ELANA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ELANA
Last Name:MORA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1978
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32050-1978
Mailing Address - Country:US
Mailing Address - Phone:904-861-1034
Mailing Address - Fax:904-861-1037
Practice Address - Street 1:3839 COUNTY ROAD 218
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-5708
Practice Address - Country:US
Practice Address - Phone:904-861-1034
Practice Address - Fax:904-861-1037
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065318208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23858Medicare ID - Type Unspecified
FLF74739Medicare UPIN