1508099789 NPI number — DR. MORGAN KENNEDY MCEVOY D.M.D.

Table of content: DR. MORGAN KENNEDY MCEVOY D.M.D. (NPI 1508099789)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508099789 NPI number — DR. MORGAN KENNEDY MCEVOY D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCEVOY
Provider First Name:
MORGAN
Provider Middle Name:
KENNEDY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KENNEDY
Provider Other First Name:
MORGAN
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508099789
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
114 ORANGE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRHOPE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36532-1200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-709-7040
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22645 HWY 59 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROBERTSDALE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36567-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-621-1370
Provider Business Practice Location Address Fax Number:
251-621-1374
Provider Enumeration Date:
09/03/2009

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: 122300000X , with the licence number:  5688 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 9261 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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