Provider Demographics
NPI:1790773703
Name:MORALES, RALPH W (DO)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:W
Last Name:MORALES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3231 GLYNN AVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4851
Mailing Address - Country:US
Mailing Address - Phone:912-265-9006
Mailing Address - Fax:912-265-7200
Practice Address - Street 1:3231 GLYNN AVE
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4851
Practice Address - Country:US
Practice Address - Phone:912-265-9006
Practice Address - Fax:912-265-7200
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA31480207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00612675EMedicaid
GAF84523Medicare UPIN
GA20BDCWQMedicare PIN
GA200031238Medicare PIN