Provider Demographics
NPI:1225262306
Name:MORGAN, JONATHAN T (DO)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:T
Last Name:MORGAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:333 N 18TH AVE
Mailing Address - Street 2:SUITE B4
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201
Mailing Address - Country:US
Mailing Address - Phone:208-232-2233
Mailing Address - Fax:208-232-2299
Practice Address - Street 1:333 N 18TH AVE
Practice Address - Street 2:SUITE B4
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201
Practice Address - Country:US
Practice Address - Phone:208-232-2233
Practice Address - Fax:208-232-2299
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS05-33734207T00000X
COCDR.0000131207T00000X
IDO-0644207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery