Provider Demographics
NPI:1346338019
Name:MORGAN, JEFFREY DEMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DEMOND
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 1:4611 HARD SCRABBLE RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8584
Mailing Address - Country:US
Mailing Address - Phone:843-319-9432
Mailing Address - Fax:800-640-5242
Practice Address - Street 1:300 E OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 356
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-2148
Practice Address - Country:US
Practice Address - Phone:843-319-9432
Practice Address - Fax:800-640-5242
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088881207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC236364Medicaid
FLDG494ZMedicare PIN
SC236364Medicaid
SCH470776545Medicare ID - Type Unspecified
MIOM96680Medicare ID - Type Unspecified