Provider Demographics
NPI:1710957147
Name:MORALES, CARLOS JUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:JUAN
Last Name:MORALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CARLOS
Other - Middle Name:JUAN
Other - Last Name:MORALES-SERRANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:622 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2594
Mailing Address - Country:US
Mailing Address - Phone:727-512-4389
Mailing Address - Fax:
Practice Address - Street 1:800 W RANDOL MILL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2504
Practice Address - Country:US
Practice Address - Phone:817-548-6205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90250207P00000X
TXM4374207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181796701Medicaid
TX8W0182OtherBCBS
TX181796702Medicaid
TX181796703Medicaid
TX8BT326OtherBCBS THRU SAEMA
TXP00352212Medicare PIN
TX8F9885Medicare PIN
TX8G6399Medicare PIN
TX181796701Medicaid
TX8G7509Medicare PIN