Provider Demographics
NPI:1124306329
Name:MORALES, DAVID G JR (SFIDC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:G
Last Name:MORALES
Suffix:JR
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9180 TENANGO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79907-3257
Mailing Address - Country:US
Mailing Address - Phone:915-491-2533
Mailing Address - Fax:
Practice Address - Street 1:9180 TENANGO DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79907-3257
Practice Address - Country:US
Practice Address - Phone:915-491-2533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman