Provider Demographics
NPI:1730273855
Name:MORGAN, JAMES D (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
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 1:1530 W CENTER ST APT 344
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-4277
Mailing Address - Country:US
Mailing Address - Phone:209-624-5288
Mailing Address - Fax:209-624-5289
Practice Address - Street 1:330 NORTHGATE DR
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-3139
Practice Address - Country:US
Practice Address - Phone:209-624-5288
Practice Address - Fax:209-624-5289
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G491920208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0070180Medicaid
CAG49192OtherMEDICAL LICENSE
CAGR0070182Medicaid
CAGR0070181Medicaid
CAGR0070181Medicaid
CAGR0070181Medicaid
CAMMM00292MMedicare ID - Type UnspecifiedMEDICARE GROUP NO