Healthcare Provider Details

I. General information

NPI: 1619099926
Provider Name (Legal Business Name): W GREGORY MORGAN III MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 RENAISSANCE BLVD SUITE 100
EDMOND OK
73013-3041
US

IV. Provider business mailing address

6608 N WESTERN AVE # 493
OKLAHOMA CITY OK
73116-7326
US

V. Phone/Fax

Practice location:
  • Phone: 405-715-4496
  • Fax: 405-682-8044
Mailing address:
  • Phone: 405-418-4800
  • Fax: 405-418-4820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number10222
License Number StateOK

VIII. Authorized Official

Name: WILLIAM GREGORY MORGAN
Title or Position: OWNER DOCTOR
Credential: MD
Phone: 405-359-5477