Healthcare Provider Details

I. General information

NPI: 1376984435
Provider Name (Legal Business Name): BRETON L MORGAN, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2907 JACKSON AVE
PT PLEASANT WV
25550-1715
US

IV. Provider business mailing address

2907 JACKSON AVE
PT PLEASANT WV
25550-1715
US

V. Phone/Fax

Practice location:
  • Phone: 304-675-6492
  • Fax: 304-675-3782
Mailing address:
  • Phone: 304-675-6492
  • Fax: 304-675-3782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15143
License Number StateWV

VIII. Authorized Official

Name: BRETON L MORGAN
Title or Position: OWNER
Credential: M.D.
Phone: 304-675-6492