Healthcare Provider Details

I. General information

NPI: 1669760930
Provider Name (Legal Business Name): MORGAN C WILLSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 07/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W THOMAS RD
PHOENIX AZ
85013-4409
US

IV. Provider business mailing address

350 W THOMAS RD
PHOENIX AZ
85013-4409
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-7783
  • Fax: 602-406-4550
Mailing address:
  • Phone: 602-406-7783
  • Fax: 602-406-4550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberR72593
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: