Individual
PATRICK G MORA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
9981 S HEALTHPARK DR, SUITE 120, FORT MYERS, FL 33908-3618
(239) 343-6341
(239) 343-6342
Mailing address
PO BOX 2147, FORT MEYERS, FL 33902-2147
(239) 343-6341
(239) 343-6342
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9100684
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
192485
AMERIGROUP
FL
05
—
2904659-00
—
FL
05
—
290465900
—
FL
Enumeration date
04/10/2006
Last updated
03/30/2021
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