Provider Demographics
NPI:1114130747
Name:MORGAN, JON ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:ROBERT
Last Name:MORGAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12112 W KELLOGG ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-1100
Mailing Address - Country:US
Mailing Address - Phone:316-440-1100
Mailing Address - Fax:316-440-1089
Practice Address - Street 1:12112 W KELLOGG ST
Practice Address - Street 2:SUITE 300
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67235-1100
Practice Address - Country:US
Practice Address - Phone:316-440-1100
Practice Address - Fax:316-440-1089
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-01205213ES0103X
KS12-00365213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS114146OtherBCBS
KS200428960AMedicaid
KS200428960GMedicaid
KS200428960GMedicaid
KS114146OtherBCBS