Provider Demographics
NPI:1942284831
Name:DE MORAES, ALEXANDRE ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRE
Middle Name:ANTONIO
Last Name:DE MORAES
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 1:3010 BEARD RD
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3442
Mailing Address - Country:US
Mailing Address - Phone:707-255-8825
Mailing Address - Fax:707-252-9325
Practice Address - Street 1:3010 BEARD RD
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3442
Practice Address - Country:US
Practice Address - Phone:707-257-1550
Practice Address - Fax:707-257-8219
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-03
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66851207Q00000X
WAMD60183294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH09912Medicare UPIN