Provider Demographics
NPI:1578629135
Name:MORGAN, STACY BRIDGETTE (DO)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:BRIDGETTE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12734 KENWOOD LN
Mailing Address - Street 2:SUITE 84
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5666
Mailing Address - Country:US
Mailing Address - Phone:239-936-5250
Mailing Address - Fax:386-409-9207
Practice Address - Street 1:12734 KENWOOD LN
Practice Address - Street 2:SUITE 84
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5666
Practice Address - Country:US
Practice Address - Phone:239-936-5250
Practice Address - Fax:386-409-9207
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS90202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
02841Medicare ID - Type Unspecified
FLH90925Medicare UPIN