Healthcare Provider Details

I. General information

NPI: 1164588463
Provider Name (Legal Business Name): BEVERLY MORGAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 GRAND CANAL BLVD STE 105
STOCKTON CA
95207-8117
US

IV. Provider business mailing address

4884 LOWREY RD
OAKLAND CA
94605-5726
US

V. Phone/Fax

Practice location:
  • Phone: 209-953-3611
  • Fax:
Mailing address:
  • Phone: 510-638-3270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA22426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: