Provider Demographics
NPI:1134170657
Name:MORALES, J MARK (MD)
Entity type:Individual
Prefix:DR
First Name:J
Middle Name:MARK
Last Name:MORALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 30104
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78463-0104
Mailing Address - Country:US
Mailing Address - Phone:361-854-0201
Mailing Address - Fax:361-855-7572
Practice Address - Street 1:1224 3RD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2354
Practice Address - Country:US
Practice Address - Phone:361-854-0201
Practice Address - Fax:361-855-7572
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ54178208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141578801Medicaid
TX00232RMedicare ID - Type Unspecified
TX141578801Medicaid
TX8504MIMedicare PIN