Provider Demographics
NPI:1083764294
Name:MORGAN, RANDAL W (PA)
Entity Type:Individual
Prefix:MR
First Name:RANDAL
Middle Name:W
Last Name:MORGAN
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:2500 W ILLINOIS AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-6339
Mailing Address - Country:US
Mailing Address - Phone:432-699-2370
Mailing Address - Fax:432-697-3524
Practice Address - Street 1:2500 W ILLINOIS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6339
Practice Address - Country:US
Practice Address - Phone:432-699-2370
Practice Address - Fax:432-697-3524
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2014-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA03979363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B7858Medicare ID - Type UnspecifiedMEDICARE
TXQ16763Medicare UPIN