Provider Demographics
NPI:1588687982
Name:RODGERS-MORALES, PATRICE DALE (MD)
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:DALE
Last Name:RODGERS-MORALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:NC
Mailing Address - Zip Code:28164-1438
Mailing Address - Country:US
Mailing Address - Phone:704-263-8945
Mailing Address - Fax:704-263-2591
Practice Address - Street 1:700 N MAIN ST
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:NC
Practice Address - Zip Code:28164-1438
Practice Address - Country:US
Practice Address - Phone:704-263-8945
Practice Address - Fax:704-263-2591
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10006693207Q00000X
NC9900669207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine