MEDICARE: PHILIP JEROME MORGAN CSFA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZS0410X	Surgical Technologist	114003	FL

General Provider Information

NPI Number	:	1093142788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP JEROME MORGAN CSFA

Provider Business Mailing Address
First Line	:	6312 INTERBAY AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-4909
Country	:	US
Telephone Number	:	813-449-1966
Fax Number	:

Provider Business Practice Location Address
First Line	:	6312 INTERBAY AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-4909
Country	:	US
Telephone Number	:	813-449-1966
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2013
Last Update Date	:	09/26/2013

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