Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | E1613 | CA |
N | 222Z00000X | Podiatrist | E1613 | CA |
N | 213EP1101X | Primary Podiatric Medicine | E1613 | CA |
N | 111NR0200X | Radiology | E1614 | CA |
N | 213ER0200X | Radiology | E1614 | CA |
N | 2081S0010X | Sports Medicine | E1613 | CA |
N | 213ES0000X | Sports Medicine | E1613 | CA |
N | 213ES0103X | Foot & Ankle Surgery | E1613 | CA |
Y | 213ES0131X | Foot Surgery | E1613 | CA |
NPI | 1669475489 |
---|---|
Provider Name | Dr. Jack Morgan |
First Address | Monterey Park, CA 91754-1242 |
Second Address | Monterey Park, CA 91754-1242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 15/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E16131 | (05) | CA |
T11008 | (02) | CA |