Provider Demographics
NPI:1225024144
Name:MORALES, FERNANDO IVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:IVAN
Last Name:MORALES
Suffix:
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 1:6755 GALL BLVD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-2522
Mailing Address - Country:US
Mailing Address - Phone:813-782-4439
Mailing Address - Fax:813-782-4317
Practice Address - Street 1:6755 GALL BLVD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-2522
Practice Address - Country:US
Practice Address - Phone:813-782-4439
Practice Address - Fax:813-782-4317
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044937208D00000X
FLME 44937207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL043679800Medicaid
FL30789XMedicare PIN
D85574Medicare UPIN