Provider Demographics
NPI:1861471641
Name:MORALES, IAN J (MD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:J
Last Name:MORALES
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 1:10660 SW 44TH CT
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-2100
Mailing Address - Country:US
Mailing Address - Phone:954-474-8579
Mailing Address - Fax:
Practice Address - Street 1:10660 SW 44TH CT
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-2100
Practice Address - Country:US
Practice Address - Phone:954-474-8579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96539207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277231100Medicaid
FL29255OtherBLUE CROSS BLUE SHIELD
FLP00405465OtherRAILROAD MEDICARE
FLN359270OtherWELLCARE
FLP00405465OtherRAILROAD MEDICARE
FLAB294ZMedicare PIN
TNH17008Medicare UPIN
FL277231100Medicaid