Provider Demographics
NPI:1376536110
Name:MORGAN, ELIZABETH ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1554
Mailing Address - Street 2:
Mailing Address - City:SANDIA PARK
Mailing Address - State:NM
Mailing Address - Zip Code:87047-1554
Mailing Address - Country:US
Mailing Address - Phone:505-281-5274
Mailing Address - Fax:505-281-0311
Practice Address - Street 1:45A LOS RANCHITOS RD
Practice Address - Street 2:
Practice Address - City:SANDIA PARK
Practice Address - State:NM
Practice Address - Zip Code:87047-9619
Practice Address - Country:US
Practice Address - Phone:505-281-5274
Practice Address - Fax:505-281-0311
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2001-267207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8352577Medicaid
WAAB37009Medicare ID - Type Unspecified
WA8352577Medicaid