Basic Information
| Provider Information | |||||||||
| NPI: | 1205899937 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORCOS | ||||||||
| FirstName: | JACQUES | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D., FRCS(ENG), FRC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1095 NW 14TH TERRACE | ||||||||
| Address2: | LOIS POPE LIFE CENTER | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3022436946 | ||||||||
| FaxNumber: | 3052433337 | ||||||||
| Practice Location | |||||||||
| Address1: | 1475 NW 12TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052436946 | ||||||||
| FaxNumber: | 3052433337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2006 | ||||||||
| LastUpdateDate: | 02/03/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | ME68833 | FL | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | ME0068833 | FL | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 378136400 | 05 | FL | MEDICAID | 3781364-00 | 05 | FL | MEDICAID |