Provider Demographics
NPI:1356342240
Name:MORALES, BYRON B (MD)
Entity type:Individual
Prefix:
First Name:BYRON
Middle Name:B
Last Name:MORALES
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 1:885 N SANDUSKY AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:43351-1031
Mailing Address - Country:US
Mailing Address - Phone:419-294-1525
Mailing Address - Fax:419-209-0252
Practice Address - Street 1:885 N SANDUSKY AVE
Practice Address - Street 2:
Practice Address - City:UPPER SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:43351-1031
Practice Address - Country:US
Practice Address - Phone:419-294-1525
Practice Address - Fax:419-209-0252
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.066941207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0978385Medicaid
000000030473OtherANTHEM BC/BS
OH0978385Medicaid
OHMO7226031Medicare ID - Type Unspecified