Healthcare Provider Details

I. General information

NPI: 1619610771
Provider Name (Legal Business Name): SCOTT MORGAN PA-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2022
Last Update Date: 04/17/2022
Certification Date: 04/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4430 MISSOURI AVE
FORT LEONARD WOOD MO
65473-9098
US

IV. Provider business mailing address

104 CROSSCUT RD
SAINT ROBERT MO
65584-8610
US

V. Phone/Fax

Practice location:
  • Phone: 573-596-0035
  • Fax:
Mailing address:
  • Phone: 765-425-3083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: