Provider Demographics
NPI:1639160245
Name:MORGAN, TED OLIN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:OLIN
Last Name:MORGAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-0428
Mailing Address - Country:US
Mailing Address - Phone:307-739-7690
Mailing Address - Fax:307-739-4970
Practice Address - Street 1:555 E BROADWAY AVE STE 229
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001
Practice Address - Country:US
Practice Address - Phone:307-739-7690
Practice Address - Fax:307-739-4970
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2021-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA74832208800000X
WY11507A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY149791000Medicaid
MA2130912Medicaid
MAA41039Medicare PIN