Healthcare Provider Details

I. General information

NPI: 1083764294
Provider Name (Legal Business Name): RANDAL W MORGAN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W ILLINOIS AVE SUITE 100
MIDLAND TX
79701-6339
US

IV. Provider business mailing address

2500 W ILLINOIS AVE SUITE 100
MIDLAND TX
79701-6339
US

V. Phone/Fax

Practice location:
  • Phone: 432-699-2370
  • Fax: 432-697-3524
Mailing address:
  • Phone: 432-699-2370
  • Fax: 432-697-3524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA03979
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: