Healthcare Provider Details

I. General information

NPI: 1982686655
Provider Name (Legal Business Name): JOHN DAVID MORGAN III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

PO BOX 379
ORLAND PARK IL
60462-0379
US

V. Phone/Fax

Practice location:
  • Phone: 708-346-3055
  • Fax:
Mailing address:
  • Phone: 708-460-9836
  • Fax: 708-460-1117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number036082151
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: