Provider Demographics
NPI:1306166483
Name:MORALES CARDONA, AMILCAR LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:AMILCAR
Middle Name:LUIS
Last Name:MORALES CARDONA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:AMILCAR
Other - Middle Name:L
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 35629
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-0629
Mailing Address - Country:US
Mailing Address - Phone:214-424-2213
Mailing Address - Fax:214-231-2159
Practice Address - Street 1:6317 HARRIS PKWY STE 300
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4258
Practice Address - Country:US
Practice Address - Phone:817-361-6900
Practice Address - Fax:817-522-1968
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101251307207R00000X, 207RG0100X, 207RI0008X
TXS4824207RT0003X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX408506001Medicaid
TX408506002OtherCSHCN