Provider Demographics
NPI:1508193541
Name:FERNANDO IVAN MORALES MD PA
Entity Type:Organization
Organization Name:FERNANDO IVAN MORALES MD PA
Other - Org Name:CARING PHYSICIAN MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD PA
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:813-782-4439
Mailing Address - Street 1:6755 GALL BLVD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-2522
Mailing Address - Country:US
Mailing Address - Phone:813-782-4439
Mailing Address - Fax:813-782-4317
Practice Address - Street 1:6755 GALL BLVD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-2522
Practice Address - Country:US
Practice Address - Phone:813-782-4439
Practice Address - Fax:813-782-4317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044937261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30789Medicare PIN