Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | P9851 | TX |
NPI | 1558522615 |
---|---|
Provider Name | Dr. Morgan Taylor Fordham JR. |
First Address | San Antonio, TX 78207-3255 |
Second Address | San Antonio, TX 78207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2008 |
Last Update Date | 11/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
337643601 | (05) | TX |