Provider Demographics
NPI:1114996170
Name:MORAES, MANOEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MANOEL
Middle Name:
Last Name:MORAES
Suffix:JR
Gender:M
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 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-9567
Mailing Address - Fax:239-343-9571
Practice Address - Street 1:8925 COLONIAL CENTER DR STE 2001
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7813
Practice Address - Country:US
Practice Address - Phone:239-343-9567
Practice Address - Fax:239-343-9571
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238947207RX0202X
FLME105427207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111315500Medicaid
F05176Medicare UPIN