Provider Demographics
NPI:1215315320
Name:MORALES, MELEAH ANN CROCKETT (DO)
Entity type:Individual
Prefix:DR
First Name:MELEAH
Middle Name:ANN CROCKETT
Last Name:MORALES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MELEAH
Other - Middle Name:ANN
Other - Last Name:CROCKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:440 E TAMPA ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65806-1131
Mailing Address - Country:US
Mailing Address - Phone:417-831-0150
Mailing Address - Fax:
Practice Address - Street 1:440 E TAMPA ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65806
Practice Address - Country:US
Practice Address - Phone:417-831-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-08
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018027031208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics