Healthcare Provider Details

I. General information

NPI: 1962149997
Provider Name (Legal Business Name): JACOB DAVID MORGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 E LEXINGTON AVE
DANVILLE KY
40422-1719
US

IV. Provider business mailing address

PO BOX 990
DANVILLE KY
40423-0990
US

V. Phone/Fax

Practice location:
  • Phone: 859-239-4950
  • Fax: 859-239-4959
Mailing address:
  • Phone: 859-239-4950
  • Fax: 859-239-4959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number61732
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number88139
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number61732
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: