Provider Demographics
NPI:1508897919
Name:MORGAN, BRETON L (MD)
Entity Type:Individual
Prefix:
First Name:BRETON
Middle Name:L
Last Name:MORGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2907 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:PT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550-1715
Mailing Address - Country:US
Mailing Address - Phone:304-675-6492
Mailing Address - Fax:304-675-3782
Practice Address - Street 1:2907 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:PT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-1715
Practice Address - Country:US
Practice Address - Phone:304-675-6492
Practice Address - Fax:304-675-3782
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WVE05102207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVE05102Medicare UPIN
WVMO0601952Medicare ID - Type Unspecified