Provider Demographics
NPI:1255416715
Name:MORO, GEORGE ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ROBERT
Last Name:MORO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1140 W LA VETA AVE
Mailing Address - Street 2:SUITE 830
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4223
Mailing Address - Country:US
Mailing Address - Phone:714-836-1595
Mailing Address - Fax:714-836-1598
Practice Address - Street 1:1140 W LA VETA AVE
Practice Address - Street 2:SUITE 830
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4223
Practice Address - Country:US
Practice Address - Phone:714-836-1595
Practice Address - Fax:714-836-1598
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG64452208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery