Provider Demographics
NPI:1871525451
Name:MORALES, LUIS E (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:E
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 1:809 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2008
Mailing Address - Country:US
Mailing Address - Phone:407-682-7272
Mailing Address - Fax:407-682-7274
Practice Address - Street 1:809 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2008
Practice Address - Country:US
Practice Address - Phone:407-682-7272
Practice Address - Fax:407-682-7274
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44936207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79955AMedicare ID - Type Unspecified
FLD86383Medicare UPIN