Provider Demographics
NPI:1124081120
Name:MORALES, ROMMEL R (MD)
Entity type:Individual
Prefix:
First Name:ROMMEL
Middle Name:R
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 1:11410 N KENDALL DR
Mailing Address - Street 2:SUITE B210
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1031
Mailing Address - Country:US
Mailing Address - Phone:305-596-4123
Mailing Address - Fax:
Practice Address - Street 1:11410 N KENDALL DR
Practice Address - Street 2:SUITE B210
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1031
Practice Address - Country:US
Practice Address - Phone:305-596-4123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61353208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001709OtherNHP
FL18440OtherBLUE CROSS BLUE SHIELD
FLN220289OtherWELLCARE
FL21086504290OtherBEECHSTREET
FL29864OtherCOVENTRY
FL214769OtherAVMED
FLSG030245OtherVISTA
FL107436OtherHUMANA
FL371564700Medicaid
FL4251841OtherAETNA
FL3943660007OtherCIGNA
FL1056700OtherUNITED HEALTHCARE
FL200756OtherAMERIGROUP
FL732262OtherFIRST HEALTH