Provider Demographics
NPI:1134120413
Name:MORGAN, RUFFIN SMITH (PHYSICIANS ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:RUFFIN
Middle Name:SMITH
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PHYSICIANS ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WEST MEDICAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-6773
Mailing Address - Country:US
Mailing Address - Phone:336-249-3329
Mailing Address - Fax:336-249-3795
Practice Address - Street 1:102 WEST MEDICAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-6773
Practice Address - Country:US
Practice Address - Phone:336-249-3329
Practice Address - Fax:336-249-3795
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102401207Q00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2751807Medicare ID - Type Unspecified
S80513Medicare UPIN