Basic Information
| Provider Information | |||||||||
| NPI: | 1013448596 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORALES | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 14TH ST SE | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341173695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7867258799 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9981 S HEALTHPARK DR | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339083618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393432052 | ||||||||
| FaxNumber: | 2393435348 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2017 | ||||||||
| LastUpdateDate: | 03/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME145277 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | ME145277 | FL | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | ME145277 | 01 | FL | MEDICAL LICENSE | OTHER | 108621100 | 05 | FL | MEDICAID |