Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RX0202X | Medical Oncology | 0101238947 | VA |
Y | 207RX0202X | Medical Oncology | ME105427 | FL |
NPI | 1114996170 |
---|---|
Provider Name | Dr. Manoel Moraes JR. |
First Address | Fort Myers, FL 33902-2147 |
Second Address | Fort Myers, FL 33905-7813 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 10/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
111315500 | (05) | FL |
F05176 | (02) |