Provider Demographics
NPI:1326575168
Name:MORGAN, JACOB IRA (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:IRA
Last Name:MORGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 PERRY WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8307
Mailing Address - Country:US
Mailing Address - Phone:601-906-8434
Mailing Address - Fax:
Practice Address - Street 1:104 PERRY WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-8307
Practice Address - Country:US
Practice Address - Phone:601-906-8434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10060356207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine