Provider Demographics
NPI:1699756049
Name:MORALES, EDELMIRO ROBERTO JR (CRNA, PA-C)
Entity type:Individual
Prefix:MR
First Name:EDELMIRO
Middle Name:ROBERTO
Last Name:MORALES
Suffix:JR
Gender:M
Credentials:CRNA, PA-C
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Mailing Address - Street 1:2402 N ED CAREY DR APT 37
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8256
Mailing Address - Country:US
Mailing Address - Phone:956-279-7303
Mailing Address - Fax:956-423-3118
Practice Address - Street 1:1702 N ED CAREY DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8202
Practice Address - Country:US
Practice Address - Phone:956-423-4589
Practice Address - Fax:956-423-9574
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2009-05-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA03406363A00000X
TX651740367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant