Provider Demographics
NPI:1417480799
Name:HUNGENBERG, MORGAN (DO)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:HUNGENBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 POWDERHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-4800
Mailing Address - Country:US
Mailing Address - Phone:307-634-1311
Mailing Address - Fax:307-634-1271
Practice Address - Street 1:5050 POWDERHOUSE RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4800
Practice Address - Country:US
Practice Address - Phone:307-634-1311
Practice Address - Fax:307-634-1271
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0061304207Q00000X
WY16023A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000149783Medicaid