Provider Demographics
NPI:1730610155
Name:MORALES MORENO, JOSE EMILIO (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:EMILIO
Last Name:MORALES MORENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 S GRAND BLVD RM 2717
Mailing Address - Street 2:SSM HEALTH CARDINAL GLENNON CHILDREN'S HOSPITAL
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1003
Mailing Address - Country:US
Mailing Address - Phone:314-577-5634
Mailing Address - Fax:314-577-5616
Practice Address - Street 1:1465 S GRAND BLVD RM 2717
Practice Address - Street 2:SSM HEALTH CARDINAL GLENNON CHILDREN'S HOSPITAL
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1003
Practice Address - Country:US
Practice Address - Phone:314-577-5634
Practice Address - Fax:314-577-5616
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11705342-12052080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine