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General NPI Number Information
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NPI Number | 1609916998
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Entity Type | Organization
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Legal Business Name | JERRY S MORGAN M D L L C
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 625 N MONTE VISTA ST
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City | ADA
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State | OK
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Zip | 74820-4613
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Country | US
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Telephone | 580-332-3211
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Fax |
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Provider Business Mailing Address
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Address Line | 625 N MONTE VISTA ST
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City | ADA
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State | OK
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Zip | 74820-4613
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Country | US
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Telephone | 580-332-3211
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JERRY S MORGAN
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Credential | M.D.
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Telephone | 580-332-3211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 10006
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License Number State | OK
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