Provider Demographics
NPI:1265443089
Name:MORALE, SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:MORALE
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 1:6534 WAGNER WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-2004
Mailing Address - Country:US
Mailing Address - Phone:210-393-6829
Mailing Address - Fax:210-698-9386
Practice Address - Street 1:6534 WAGNER WAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78256
Practice Address - Country:US
Practice Address - Phone:210-393-6829
Practice Address - Fax:210-698-9386
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9550207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116185303Medicaid
UT116185302OtherCSHCN
UT116185302OtherCSHCN
TX81545JMedicare PIN