Healthcare Provider Details

I. General information

NPI: 1265472864
Provider Name (Legal Business Name): WILLIAM ROBERT MORGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 MIAMI AVE W
VENICE FL
34285-2361
US

IV. Provider business mailing address

1101 TAMIAMI TRL S SUITE 101
VENICE FL
34285-4133
US

V. Phone/Fax

Practice location:
  • Phone: 941-484-4778
  • Fax: 941-485-8062
Mailing address:
  • Phone: 941-480-2831
  • Fax: 941-485-8062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0062802
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: