Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 26754 | MN |
NPI | 1760557888 |
---|---|
Provider Name | Jeffery Carl Morgan |
First Address | St. Louis Park, MN 55416 |
Second Address | St. Louis Park, MN 55416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 09/01/2019 |