Healthcare Provider Details

I. General information

NPI: 1831357516
Provider Name (Legal Business Name): JEFFREY G MORGAN A PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 09/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 CONNIE AVE STE 108
SALEM IN
47167-2305
US

IV. Provider business mailing address

104 CONNIE AVE STE 108
SALEM IN
47167-2305
US

V. Phone/Fax

Practice location:
  • Phone: 812-883-2696
  • Fax: 812-883-3706
Mailing address:
  • Phone: 812-883-2696
  • Fax: 812-883-3706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01035453
License Number StateIN

VIII. Authorized Official

Name: DR. JEFFREY G MORGAN
Title or Position: OWNER
Credential: MD
Phone: 812-883-2696