Provider Demographics
NPI:1114961554
Name:MORGENTHAL, CRAIG B (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:B
Last Name:MORGENTHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11945 SAN JOSE BLVD
Mailing Address - Street 2:BLDG 300
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1627
Mailing Address - Country:US
Mailing Address - Phone:904-396-1725
Mailing Address - Fax:904-399-1717
Practice Address - Street 1:836 PRUDENTIAL DR
Practice Address - Street 2:SUITE 1001
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8334
Practice Address - Country:US
Practice Address - Phone:904-398-0033
Practice Address - Fax:904-398-6774
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME97599208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306906OtherAVMED
FL5850547OtherCIGNA
FL93691OtherBLUE CROSS BLUE SHIELD
P00440983OtherRAILROAD MEDICARE
FL7657775OtherAETNA
FL277839400Medicaid
P00440983OtherRAILROAD MEDICARE
FL277839400Medicaid