Provider Demographics
NPI:1700875119
Name:MORERA, ISMAEL S (MD)
Entity Type:Individual
Prefix:MR
First Name:ISMAEL
Middle Name:S
Last Name:MORERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9737 NW 41ST ST
Mailing Address - Street 2:#386
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33178
Mailing Address - Country:US
Mailing Address - Phone:305-836-5627
Mailing Address - Fax:305-835-4453
Practice Address - Street 1:777 EAST 25TH ST
Practice Address - Street 2:STE 311
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013
Practice Address - Country:US
Practice Address - Phone:305-836-5627
Practice Address - Fax:305-835-4453
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0060059208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
BM2887947OtherDEA
FL27782Medicare ID - Type Unspecified
G12790Medicare UPIN