Provider Demographics
NPI:1326165523
Name:CECIL D MORGAN JR DPM INC
Entity Type:Organization
Organization Name:CECIL D MORGAN JR DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CECIL
Authorized Official - Middle Name:DELMAR
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:903-729-1552
Mailing Address - Street 1:123 MEDICAL DR
Mailing Address - Street 2:STE C
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801
Mailing Address - Country:US
Mailing Address - Phone:903-729-1552
Mailing Address - Fax:903-729-7635
Practice Address - Street 1:123 MEDICAL DR
Practice Address - Street 2:STE C
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801
Practice Address - Country:US
Practice Address - Phone:903-729-1552
Practice Address - Fax:903-729-7635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0545213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX480928329OtherUNITED HEALTHCARE
TX120620303Medicaid
TX0810764-01Medicaid
TX87750FOtherBCBS
TX87750FOtherBCBS
T98112Medicare UPIN
TX120620303Medicaid
TXCG2355Medicare PIN