Provider Demographics
NPI:1417903527
Name:JAVIER, MARCOS MORALES (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCOS
Middle Name:MORALES
Last Name:JAVIER
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 1:6930 LICK RUN LYRA RD
Mailing Address - Street 2:PO BOX 471
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-8711
Mailing Address - Country:US
Mailing Address - Phone:740-574-1534
Mailing Address - Fax:
Practice Address - Street 1:1540 SPRING VALLEY DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704-9300
Practice Address - Country:US
Practice Address - Phone:304-429-6741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080819207L00000X
WV22560207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH050091137OtherRAILROAD MEDICARE
OH000000254484OtherBCBS
OH2375317Medicaid
KY6405943900Medicaid
OHJA4099301Medicare ID - Type Unspecified