Provider Demographics
NPI:1972511566
Name:MORALES-LOPEZ, ANTONIO R (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:R
Last Name:MORALES-LOPEZ
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:PO BOX 9509
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-9509
Mailing Address - Country:US
Mailing Address - Phone:787-258-4222
Mailing Address - Fax:787-704-3488
Practice Address - Street 1:55 CALLE SATURNO - EL VERDE
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-6336
Practice Address - Country:US
Practice Address - Phone:787-258-4222
Practice Address - Fax:787-704-3488
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6113207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0097540Medicare ID - Type Unspecified
PRC84119Medicare UPIN