Basic Information
| Provider Information | |||||||||
| NPI: | 1144752957 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORGAN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2748 MILTON WAY STE 101 | ||||||||
| Address2: | |||||||||
| City: | MILTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983549379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539225262 | ||||||||
| FaxNumber: | 2539225299 | ||||||||
| Practice Location | |||||||||
| Address1: | 2748 MILTON WAY STE 101 | ||||||||
| Address2: | |||||||||
| City: | MILTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983549379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539225262 | ||||||||
| FaxNumber: | 2539225299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2017 | ||||||||
| LastUpdateDate: | 03/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | DO.OP.61054639 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | DO.OP.61054639 | 01 | WA | WASHINGTON STATE LICENSE | OTHER | FM8211485 | 01 | DEA | OTHER |