Provider Demographics
NPI:1578540159
Name:MORGAN, TIMOTHY A (PA C)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
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 1:200 W 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3969
Mailing Address - Country:US
Mailing Address - Phone:907-240-3376
Mailing Address - Fax:907-563-7929
Practice Address - Street 1:135 W DIMOND BLVD STE 104
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-1907
Practice Address - Country:US
Practice Address - Phone:907-240-3376
Practice Address - Fax:907-563-7929
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004578363A00000X
AK723363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK172319Medicaid
Q39080Medicare UPIN
WA8373235Medicaid