Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | MD23594 | TN |
NPI | 1033147145 |
---|---|
Provider Name | James O Morgan |
First Address | Mc Kenzie, TN 38201-1649 |
Second Address | Mc Kenzie, TN 38201-1649 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 28/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3068111 | (05) | TN |
3380640 | MEDICAID GROUP (01) | TN |
3380640 | MEDICARE GROUP (01) | TN |