Provider Demographics
NPI:1902074628
Name:MORGAN, JEFFERSON DAVIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERSON
Middle Name:DAVIS
Last Name:MORGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 MAPLEWOOD DRIVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8800
Mailing Address - Country:US
Mailing Address - Phone:561-575-1788
Mailing Address - Fax:561-575-1789
Practice Address - Street 1:801 MAPLEWOOD DRIVE
Practice Address - Street 2:SUITE 5
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-8800
Practice Address - Country:US
Practice Address - Phone:561-575-1788
Practice Address - Fax:561-575-1789
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-15
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057323207ZD0900X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14791XOtherPTAN