Provider Demographics
NPI:1922067669
Name:MORELL, VENITA WEAVER (MD)
Entity Type:Individual
Prefix:DR
First Name:VENITA
Middle Name:WEAVER
Last Name:MORELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:221 HOSPITAL DR NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5066
Mailing Address - Country:US
Mailing Address - Phone:850-833-9233
Mailing Address - Fax:850-833-9252
Practice Address - Street 1:221 HOSPITAL DR NE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5066
Practice Address - Country:US
Practice Address - Phone:850-833-9233
Practice Address - Fax:850-833-9252
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66289207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268448900Medicaid
FL37309Medicare ID - Type Unspecified
FL268448900Medicaid