Provider Demographics
NPI:1639221187
Name:MORALES SCHMIDT, RANDOLFO (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDOLFO
Middle Name:
Last Name:MORALES SCHMIDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RANDOLFO
Other - Middle Name:
Other - Last Name:MORALES SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:BOX 4185
Mailing Address - Street 2:BAYAMON GARDEN STATION
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00958
Mailing Address - Country:US
Mailing Address - Phone:787-786-7014
Mailing Address - Fax:787-740-0422
Practice Address - Street 1:30TH STREET AL17
Practice Address - Street 2:SANTA JUANITA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-786-7014
Practice Address - Fax:787-740-0422
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9218207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR69621OtherBLUE CROSS
PR29218OtherCIGNA
PR69621OtherBLUE CROSS
F88783Medicare UPIN