Provider Demographics
NPI:1083692172
Name:MORGAN, MARK EDWIN (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EDWIN
Last Name:MORGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3551 COMMERCIAL DR SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-2883
Mailing Address - Country:US
Mailing Address - Phone:507-252-0885
Mailing Address - Fax:
Practice Address - Street 1:3551 COMMERCIAL DR SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-2883
Practice Address - Country:US
Practice Address - Phone:507-252-0885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN50077207Q00000X
AZ33394207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine