Healthcare Provider Details

I. General information

NPI: 1891806295
Provider Name (Legal Business Name): JESSICA A MORGAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA A BERGAN

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 SW SIMPSON AVENUE SUITE 300
BEND OR
97702
US

IV. Provider business mailing address

1524 NW KINGSTON AVE
BEND OR
97701-2134
US

V. Phone/Fax

Practice location:
  • Phone: 541-389-7741
  • Fax: 541-278-8376
Mailing address:
  • Phone: 801-910-0380
  • Fax: 541-278-8376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5071259-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5071259-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: