Provider Demographics
NPI:1265456537
Name:MORALES, LUIS J (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:J
Last Name:MORALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 WYOMING ST
Mailing Address - Street 2:SUITE 3120
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2722
Mailing Address - Country:US
Mailing Address - Phone:937-208-5665
Mailing Address - Fax:937-208-5669
Practice Address - Street 1:1 WYOMING ST
Practice Address - Street 2:SUITE 3120
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2722
Practice Address - Country:US
Practice Address - Phone:937-208-5665
Practice Address - Fax:937-208-5669
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2014-09-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35063254207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0916290Medicaid
OH0916290Medicaid
OHMO0724601Medicare ID - Type Unspecified