Provider Demographics
NPI:1689023764
Name:MORGAN, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:MORGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 116871
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75011-6871
Mailing Address - Country:US
Mailing Address - Phone:972-922-4064
Mailing Address - Fax:
Practice Address - Street 1:6400 WINDCREST DR
Practice Address - Street 2:APT 1533
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3051
Practice Address - Country:US
Practice Address - Phone:972-922-4064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program