Provider Demographics
NPI:1902152374
Name:MORGAN PODIATRY PA
Entity Type:Organization
Organization Name:MORGAN PODIATRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:903-729-1552
Mailing Address - Street 1:123 MEDICAL DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-8510
Mailing Address - Country:US
Mailing Address - Phone:903-729-1552
Mailing Address - Fax:903-729-7635
Practice Address - Street 1:123 MEDICAL DR
Practice Address - Street 2:SUITE C
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-8510
Practice Address - Country:US
Practice Address - Phone:903-729-1552
Practice Address - Fax:903-729-7635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1366213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty