Provider Demographics
NPI:1336136696
Name:MORALES, SANTIAGO JR (MD)
Entity Type:Individual
Prefix:
First Name:SANTIAGO
Middle Name:
Last Name:MORALES
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 1:20525 AMBERFIELD DR, STE 104
Mailing Address - Street 2:
Mailing Address - City:LAND O'LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638
Mailing Address - Country:US
Mailing Address - Phone:813-536-7285
Mailing Address - Fax:
Practice Address - Street 1:34650 US HIGHWAY 19 N STE 104
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684
Practice Address - Country:US
Practice Address - Phone:727-233-4895
Practice Address - Fax:727-400-4712
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64207207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1487907OtherWELLCARE
FLP300829OtherFREEDOM
FL1008050OtherCAREPLUS
FLP200489OtherOPTIMUM
FL023403000Medicaid
FLP01828223OtherSIMPLY