Provider Demographics
NPI:1417939059
Name:MORGAN, ROYCE A (PA-C)
Entity Type:Individual
Prefix:
First Name:ROYCE
Middle Name:A
Last Name:MORGAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 DEBARR RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2952
Mailing Address - Country:US
Mailing Address - Phone:907-279-2663
Mailing Address - Fax:907-222-1774
Practice Address - Street 1:2751 DEBARR RD
Practice Address - Street 2:SUITE 310
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2952
Practice Address - Country:US
Practice Address - Phone:907-279-2663
Practice Address - Fax:907-222-1774
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500509363A00000X
AK770363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDA0065Medicaid
AKK61683Medicare PIN
AKMDA0065Medicaid