Healthcare Provider Details

I. General information

NPI: 1063033744
Provider Name (Legal Business Name): MORGAN NICOLE TOVAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MORGAN NICOLE SMITH

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 PROVIDENCE DR
WACO TX
76707-2261
US

IV. Provider business mailing address

1600 PROVIDENCE DR
WACO TX
76707-2261
US

V. Phone/Fax

Practice location:
  • Phone: 254-313-4200
  • Fax: 254-313-4549
Mailing address:
  • Phone: 254-313-4200
  • Fax: 254-313-4549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBP10074694
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: