Provider Demographics
NPI:1376596023
Name:MORALES, RAMON A JR (DO)
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:A
Last Name:MORALES
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:205 ORCHARD DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SISSETON
Mailing Address - State:SD
Mailing Address - Zip Code:57262-2312
Mailing Address - Country:US
Mailing Address - Phone:605-698-7681
Mailing Address - Fax:605-698-3493
Practice Address - Street 1:205 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:SISSETON
Practice Address - State:SD
Practice Address - Zip Code:57262-2312
Practice Address - Country:US
Practice Address - Phone:605-698-7681
Practice Address - Fax:605-698-3493
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ4391208600000X
SD10172208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ084927Medicaid
AZ109613Medicare PIN
SDS111606Medicare PIN