Healthcare Provider Details

I. General information

NPI: 1558522615
Provider Name (Legal Business Name): MORGAN TAYLOR FORDHAM JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2008
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N. SANTA ROSA, STE LL
SAN ANTONIO TX
78207
US

IV. Provider business mailing address

315 N SAN SABA STE 1135
SAN ANTONIO TX
78207-3255
US

V. Phone/Fax

Practice location:
  • Phone: 210-704-4711
  • Fax:
Mailing address:
  • Phone: 210-704-3391
  • Fax: 210-704-4520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberP9851
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: