Provider Demographics
NPI:1740404672
Name:MORGAN, EVAN (PA)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:MORGAN
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2720 N HARBOR BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-2609
Mailing Address - Country:US
Mailing Address - Phone:714-449-6200
Mailing Address - Fax:714-449-6283
Practice Address - Street 1:2720 N HARBOR BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2609
Practice Address - Country:US
Practice Address - Phone:714-449-6200
Practice Address - Fax:714-449-6283
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA10105363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant