Healthcare Provider Details

I. General information

NPI: 1689173031
Provider Name (Legal Business Name): KEVIN NICHOLAS MORGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16513 S US HIGHWAY 301
WIMAUMA FL
33598-2032
US

IV. Provider business mailing address

5015 W NASSAU ST
TAMPA FL
33607-3814
US

V. Phone/Fax

Practice location:
  • Phone: 813-685-0827
  • Fax: 813-633-2587
Mailing address:
  • Phone: 813-356-0196
  • Fax: 813-356-0197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number159661
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: