Provider Demographics
NPI:1508849753
Name:MORALEDA, PERCIVAL HALCON (MD)
Entity Type:Individual
Prefix:
First Name:PERCIVAL
Middle Name:HALCON
Last Name:MORALEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PERRY
Other - Middle Name:HALCON
Other - Last Name:MORALEDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2900 VETERANS WAY
Mailing Address - Street 2:
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8007
Mailing Address - Country:US
Mailing Address - Phone:321-637-3788
Mailing Address - Fax:
Practice Address - Street 1:2900 VETERANS WAY
Practice Address - Street 2:
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-8007
Practice Address - Country:US
Practice Address - Phone:321-637-3788
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE51187Medicare UPIN