Provider Demographics
NPI:1649264540
Name:MORALES, PATRICIA M (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:M
Last Name:MORALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:MORALES
Other - Last Name:FINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2710 REW CIR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-2967
Mailing Address - Country:US
Mailing Address - Phone:321-221-0665
Mailing Address - Fax:407-654-9614
Practice Address - Street 1:2710 REW CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2967
Practice Address - Country:US
Practice Address - Phone:321-221-0665
Practice Address - Fax:407-654-9614
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC55742207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00284878OtherMEDICARE RR
FLP00284878OtherMEDICARE RR