Provider Demographics
NPI:1619099926
Name:W GREGORY MORGAN III MD PC
Entity Type:Organization
Organization Name:W GREGORY MORGAN III MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-359-5477
Mailing Address - Street 1:6608 N WESTERN AVE # 493
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7326
Mailing Address - Country:US
Mailing Address - Phone:405-418-4800
Mailing Address - Fax:405-418-4820
Practice Address - Street 1:1705 RENAISSANCE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3041
Practice Address - Country:US
Practice Address - Phone:405-715-4496
Practice Address - Fax:405-682-8044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10222208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKM00522008Medicare PIN