Provider Demographics
NPI:1740290246
Name:MORALES, CARMEN E (MD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:E
Last Name:MORALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:250 HARRISON STREET
Mailing Address - Street 2:PHN OFFICE
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780
Mailing Address - Country:US
Mailing Address - Phone:321-504-0556
Mailing Address - Fax:321-504-0773
Practice Address - Street 1:5005 PORT ST JOHN PKWY STE 2500
Practice Address - Street 2:
Practice Address - City:PORT ST JOHN
Practice Address - State:FL
Practice Address - Zip Code:32927-4305
Practice Address - Country:US
Practice Address - Phone:321-504-0556
Practice Address - Fax:321-504-0773
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME54747207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000620700Medicaid
FL07883VMedicare PIN
FLF13948Medicare UPIN