Provider Demographics
NPI:1710388681
Name:DE JESUS MORALES, CHARLES R (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
Last Name:DE JESUS MORALES
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:5001 EL PASO DRIVE CSB-A02
Mailing Address - Street 2:TTUHSC RADIOLOGY DPT.
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905
Mailing Address - Country:US
Mailing Address - Phone:915-215-6456
Mailing Address - Fax:
Practice Address - Street 1:4815 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2705
Practice Address - Country:US
Practice Address - Phone:915-215-6000
Practice Address - Fax:915-545-6607
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXT10452085N0700X, 2085R0202X
FL130732208D00000X
TXBP100610922085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice