Healthcare Provider Details

I. General information

NPI: 1801010129
Provider Name (Legal Business Name): ELIZABETH A MORGAN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45A LOS RANCHITOS RD
SANDIA PARK NM
87047
US

IV. Provider business mailing address

PO BOX 1554
SANDIA PARK NM
87047-1554
US

V. Phone/Fax

Practice location:
  • Phone: 505-281-5274
  • Fax: 505-281-0311
Mailing address:
  • Phone: 505-217-5274
  • Fax: 505-281-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number2001-267
License Number StateNM

VIII. Authorized Official

Name: DR. ELIZABETH ANN MORGAN
Title or Position: SOLE PROPRIETOR
Credential: MD
Phone: 505-281-5274