Provider Demographics
NPI:1144207622
Name:MORGAN, STACIE S (MD)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:S
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 840026
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0026
Mailing Address - Country:US
Mailing Address - Phone:806-212-6965
Mailing Address - Fax:806-212-6278
Practice Address - Street 1:3501 S SONCY RD
Practice Address - Street 2:STE 140
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6407
Practice Address - Country:US
Practice Address - Phone:806-355-5625
Practice Address - Fax:806-352-2245
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1136207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165092103Medicaid
TX270304YM5UMedicare UPIN
TX8A1856Medicare ID - Type Unspecified
TX040017694OtherRR MEDICARE
TX165092101Medicaid
TX8H0733OtherBCBS