Provider Demographics
NPI:1417915679
Name:MORA, PARHAM (MD)
Entity Type:Individual
Prefix:MR
First Name:PARHAM
Middle Name:
Last Name:MORA
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 1:645 MCQUEEN SMITH RD N
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-7268
Mailing Address - Country:US
Mailing Address - Phone:334-361-6126
Mailing Address - Fax:334-361-6177
Practice Address - Street 1:645 MCQUEEN SMITH RD N
Practice Address - Street 2:SUITE 205
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7268
Practice Address - Country:US
Practice Address - Phone:334-361-6126
Practice Address - Fax:334-361-6177
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20392208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529909730Medicaid
AL51501010OtherBLUE CROSS I.D.
AL020048725OtherRAILROAD MEDICARE I.D.
AL051501010Medicaid
AL51501010OtherBLUE CROSS I.D.
AL051501010Medicare UPIN