1316945363 NPI number — JERRY S MORGAN M D L L C

Table of content: JERRY S MORGAN M D L L C (NPI 1316945363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316945363 NPI number — JERRY S MORGAN M D L L C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORGAN
Provider First Name:
JERRY
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M D L L C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORGAN SOLE MBR
Provider Other First Name:
JERRY
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1316945363
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1921 STONECIPHER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ADA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-421-4570
Provider Business Mailing Address Fax Number:
580-421-6283

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1921 STONECIPHER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ADA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74820-3439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-436-3980
Provider Business Practice Location Address Fax Number:
580-272-2708
Provider Enumeration Date:
07/13/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  10006 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)