Provider Demographics
NPI:1891958484
Name:SANTIAGO MORALES MD PA
Entity Type:Organization
Organization Name:SANTIAGO MORALES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANTIAGO
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:727-791-7822
Mailing Address - Street 1:1840 MEASE DR
Mailing Address - Street 2:SUITE 408
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-6602
Mailing Address - Country:US
Mailing Address - Phone:727-791-7822
Mailing Address - Fax:727-725-8524
Practice Address - Street 1:1840 MEASE DR
Practice Address - Street 2:SUITE 408
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-6602
Practice Address - Country:US
Practice Address - Phone:727-791-7822
Practice Address - Fax:727-725-8524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64207207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00023678OtherCMS NUMBER
FLME64207OtherFLORIDA STATE LICENSE
FL377580100Medicaid
FL377580100Medicaid