Healthcare Provider Details

I. General information

NPI: 1215567623
Provider Name (Legal Business Name): MORGAN PODIATRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2308 ROYAL CT UNIT A
BRYANT AR
72022-4216
US

IV. Provider business mailing address

2308 ROYAL CT UNIT A
BRYANT AR
72022-4216
US

V. Phone/Fax

Practice location:
  • Phone: 845-461-9574
  • Fax: 501-943-7178
Mailing address:
  • Phone: 845-461-9574
  • Fax: 501-943-7178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: GINA MARIE MORGAN
Title or Position: PODIATRIST
Credential: DPM
Phone: 845-461-9574