Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | ME138277 | FL |
NPI | 1023007531 |
---|---|
Provider Name | Carlos Mora |
First Address | Jacksonville, FL 32216-3623 |
Second Address | Jacksonville, FL 32204-4786 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2005 |
Last Update Date | 08/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I21814 | (02) |