Provider Demographics
NPI:1255618682
Name:MORA PROFESSIONAL SERVICES INC
Entity type:Organization
Organization Name:MORA PROFESSIONAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:G
Authorized Official - Last Name:MORA
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:239-292-9314
Mailing Address - Street 1:12451 MCGREGOR PALMS DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3055
Mailing Address - Country:US
Mailing Address - Phone:239-292-9314
Mailing Address - Fax:
Practice Address - Street 1:12451 MCGREGOR PALMS DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3055
Practice Address - Country:US
Practice Address - Phone:239-292-9314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100684363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty