Provider Demographics
NPI:1225111941
Name:MORA, ALEXANDER III (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:MORA
Suffix:III
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 1:207 SW MILITARY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-1615
Mailing Address - Country:US
Mailing Address - Phone:210-922-2999
Mailing Address - Fax:210-921-2419
Practice Address - Street 1:207 SW MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1615
Practice Address - Country:US
Practice Address - Phone:210-922-2999
Practice Address - Fax:210-921-2419
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5972207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126953204Medicaid
TX00D69HOtherBCBS
TX126953206Medicaid
TX00D69HMedicare PIN
TX00D69HOtherBCBS