Healthcare Provider Details

I. General information

NPI: 1083692172
Provider Name (Legal Business Name): MARK EDWIN MORGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 COMMERCIAL DR SW
ROCHESTER MN
55902-2883
US

IV. Provider business mailing address

3551 COMMERCIAL DR SW
ROCHESTER MN
55902-2883
US

V. Phone/Fax

Practice location:
  • Phone: 507-252-0885
  • Fax:
Mailing address:
  • Phone: 507-252-0885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number50077
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33394
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: