Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | ME64207 | FL |
NPI | 1336136696 |
---|---|
Provider Name | Santiago Morales JR. |
First Address | Land O'lakes, FL 34638 |
Second Address | Palm Harbor, FL 34684 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2005 |
Last Update Date | 03/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
023403000 | (05) | FL |
1008050 | CAREPLUS (01) | FL |
1487907 | WELLCARE (01) | FL |
P01828223 | SIMPLY (01) | FL |
P200489 | OPTIMUM (01) | FL |
P300829 | FREEDOM (01) | FL |