Provider Demographics
NPI:1417949546
Name:MORGAN, JESSE W (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:W
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 1:1350 E MAIN ST
Mailing Address - Street 2:SUITE B-5
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-5065
Mailing Address - Country:US
Mailing Address - Phone:863-804-0200
Mailing Address - Fax:863-804-0222
Practice Address - Street 1:1350 E MAIN ST
Practice Address - Street 2:SUITE B-5
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-5065
Practice Address - Country:US
Practice Address - Phone:863-804-0200
Practice Address - Fax:863-804-0222
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62607207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372741600Medicaid
F65183Medicare UPIN
FLK2961Medicare ID - Type Unspecified