Provider Demographics
NPI:1619310596
Name:COLLOM, MORGAN LANE (DO)
Entity Type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:LANE
Last Name:COLLOM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:625 19TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1900
Mailing Address - Country:US
Mailing Address - Phone:205-934-4903
Mailing Address - Fax:205-975-7294
Practice Address - Street 1:625 19TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1900
Practice Address - Country:US
Practice Address - Phone:205-934-4903
Practice Address - Fax:205-975-7294
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALDO.1994208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery