Healthcare Provider Details

I. General information

NPI: 1255350864
Provider Name (Legal Business Name): JONATHAN M MORGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 S. FT. HARRISON AVE
CLEARWATER FL
33756
US

IV. Provider business mailing address

1330 S. FT. HARRISON AVE
CLEARWATER FL
33756
US

V. Phone/Fax

Practice location:
  • Phone: 727-441-3588
  • Fax: 727-461-1038
Mailing address:
  • Phone: 727-441-3588
  • Fax: 727-461-1038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME88962
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberME88962
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: