Provider Demographics
NPI:1790854594
Name:MOREYRA, CARLOS ESTEBAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ESTEBAN
Last Name:MOREYRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-1917
Mailing Address - Country:US
Mailing Address - Phone:850-482-0017
Mailing Address - Fax:850-633-5910
Practice Address - Street 1:4295 3RD AVE
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-2120
Practice Address - Country:US
Practice Address - Phone:850-482-0017
Practice Address - Fax:508-633-5910
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86462207X00000X, 207XX0801X
IL036.123229207XX0005X
PAMD432829208D00000X
VA0101058025208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106267600Medicaid