Provider Demographics
NPI:1760685531
Name:EUSEBIO MORALES, ERNESTO ALBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:ALBERTO
Last Name:EUSEBIO MORALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ERNESTO
Other - Middle Name:ALBERTO
Other - Last Name:EUSEBIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-0762
Mailing Address - Fax:239-343-0958
Practice Address - Street 1:13601 PLANTATION RD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912
Practice Address - Country:US
Practice Address - Phone:239-343-0762
Practice Address - Fax:239-343-0958
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085516207RS0012X
KS04-36985207RS0012X, 207RS0012X
FLME131908207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
003719300OtherMEDICARE
FL020710300Medicaid
OK200528430AOtherOK MEDICAID
KS201090580AMedicaid