Provider Demographics
NPI:1861493751
Name:MORGAN, EDWARD ALLEN (MD)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:ALLEN
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 1:1910 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-1324
Mailing Address - Country:US
Mailing Address - Phone:512-454-0405
Mailing Address - Fax:512-454-0050
Practice Address - Street 1:1910 W 35TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-1324
Practice Address - Country:US
Practice Address - Phone:512-454-0405
Practice Address - Fax:512-454-0050
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3622207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00DB43Medicare ID - Type Unspecified
C19594Medicare UPIN