Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 0101255398 | VA |
Y | 111NI0900X | Internist | 0101255398 | VA |
N | 208D00000X | General Practice Physician | 0101255398 | VA |
NPI | 1013279926 |
---|---|
Provider Name | Mario Alberto Morales |
First Address | Fort Belvoir, VA 22060-5285 |
Second Address | Fort Belvoir, VA 22060-5285 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2012 |
Last Update Date | 13/08/2015 |