Basic Information
| Provider Information | |||||||||
| NPI: | 1003903709 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PEDRO J MORALES MD & TIM P CARLSON MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2191 9TH AVE NO | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273279667 | ||||||||
| FaxNumber: | 7273211655 | ||||||||
| Practice Location | |||||||||
| Address1: | 2191 9TH AVE NO | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273279667 | ||||||||
| FaxNumber: | 7273211655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MORALES | ||||||||
| AuthorizedOfficialFirstName: | PEDRO | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7273279667 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME 41704 | FL | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ME89 730 | FL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.