Provider Demographics
NPI:1629375001
Name:FREDRIC C MORGAN, MD, INC
Entity Type:Organization
Organization Name:FREDRIC C MORGAN, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDRIC
Authorized Official - Middle Name:C
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-600-0503
Mailing Address - Street 1:1491 CEDARWOOD LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6154
Mailing Address - Country:US
Mailing Address - Phone:925-600-0503
Mailing Address - Fax:925-484-2802
Practice Address - Street 1:1491 CEDARWOOD LN
Practice Address - Street 2:SUITE A
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6154
Practice Address - Country:US
Practice Address - Phone:925-600-0503
Practice Address - Fax:925-484-2802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-19
Last Update Date:2011-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60914208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG21088Medicare UPIN
CAOOG609141Medicare PIN