Healthcare Provider Details

I. General information

NPI: 1447691480
Provider Name (Legal Business Name): MORGAN WILLIAM LYTTLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2013
Last Update Date: 04/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E AJO WAY
TUCSON AZ
85713-6204
US

IV. Provider business mailing address

1925 W RIVER RD APT. 14307
TUCSON AZ
85704-1464
US

V. Phone/Fax

Practice location:
  • Phone: 520-874-2000
  • Fax:
Mailing address:
  • Phone: 740-851-2116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR74163
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: