Provider Demographics
NPI:1528087392
Name:MORALES, LEO SERGIO (MD)
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:SERGIO
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 1:1730 MINOR AVE
Mailing Address - Street 2:1600
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1498
Mailing Address - Country:US
Mailing Address - Phone:206-287-2059
Mailing Address - Fax:206-287-2871
Practice Address - Street 1:1730 MINOR AVE
Practice Address - Street 2:1600
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1498
Practice Address - Country:US
Practice Address - Phone:206-287-2059
Practice Address - Fax:206-287-2871
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60097855207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1528087392Medicaid
CAF59243Medicare UPIN
CA00G744450Medicaid