Provider Demographics
NPI:1164588463
Name:MORGAN, BEVERLY (MD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
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 1:4884 LOWREY RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-5726
Mailing Address - Country:US
Mailing Address - Phone:510-638-3270
Mailing Address - Fax:
Practice Address - Street 1:2233 GRAND CANAL BLVD STE 105
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-8117
Practice Address - Country:US
Practice Address - Phone:209-953-3611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22426208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics