Healthcare Provider Details

I. General information

NPI: 1619941309
Provider Name (Legal Business Name): PHILIP R MORGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 WILLOW
WALLA WALLA WA
99362
US

IV. Provider business mailing address

55 W TIETAN ST
WALLA WALLA WA
99362-4445
US

V. Phone/Fax

Practice location:
  • Phone: 509-525-3720
  • Fax: 509-529-9939
Mailing address:
  • Phone: 509-525-3720
  • Fax: 509-522-1592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberMD00017276
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: