Individual
HENRY R MORA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
18404 N TATUM BLVD, STE. 101, PHOENIX, AZ 85032-1510
(602) 992-1900
(602) 485-7450
Mailing address
18185 N. 83RD AVE BLDG D STE. 107, PHOENIX, AZ 85308-0520
(623) 583-0306
(623) 583-1349
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
26554
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
205046610
TAX ID
AZ
Enumeration date
07/04/2006
Last updated
09/01/2015
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