Provider Demographics
NPI:1467554857
Name:MORGAN, JONATHAN B (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:B
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:TWO WEST 42ND STREET
Mailing Address - Street 2:STE 1500
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-0616
Mailing Address - Country:US
Mailing Address - Phone:308-635-7362
Mailing Address - Fax:308-635-0426
Practice Address - Street 1:TWO WEST 42ND STREET
Practice Address - Street 2:STE 1500
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-0616
Practice Address - Country:US
Practice Address - Phone:308-635-7362
Practice Address - Fax:308-635-0426
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4438207L00000X
MEMD24515207L00000X
NE18178207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY100908700Medicaid
260670Medicare ID - Type Unspecified