Provider Demographics
NPI:1093949448
Name:MORGAN, GINA MARIE (DPM)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8096 ZUBER RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-1683
Mailing Address - Country:US
Mailing Address - Phone:845-461-9574
Mailing Address - Fax:
Practice Address - Street 1:8096 ZUBER RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-1683
Practice Address - Country:US
Practice Address - Phone:845-461-9574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR277213E00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty