Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | S409 | NV |
NPI | 1104984418 |
---|---|
Provider Name | Dr. Mark Richard Morgan |
First Address | Reno, NV 89503-5145 |
Second Address | Reno, NV 89503-5145 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 08/07/2007 |