Provider Demographics
NPI:1750369948
Name:MORAITIS, ISIDOROS JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:ISIDOROS
Middle Name:JAMES
Last Name:MORAITIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3890 TAMPA RD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3676
Mailing Address - Country:US
Mailing Address - Phone:727-773-9796
Mailing Address - Fax:727-773-9429
Practice Address - Street 1:3890 TAMPA RD
Practice Address - Street 2:SUITE 406
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3676
Practice Address - Country:US
Practice Address - Phone:727-773-9796
Practice Address - Fax:727-773-9429
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME86072208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265583700Medicaid
FL265583700Medicaid
FL62710Medicare PIN