Provider Demographics
NPI:1851387930
Name:MORGAN, JACK L JR (DO)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:L
Last Name:MORGAN
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 SE DEBELL
Mailing Address - Street 2:BLDG A
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006
Mailing Address - Country:US
Mailing Address - Phone:918-331-1090
Mailing Address - Fax:918-331-1091
Practice Address - Street 1:3500 FRANK PHILLIPS
Practice Address - Street 2:ER DEPT
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006
Practice Address - Country:US
Practice Address - Phone:918-333-7200
Practice Address - Fax:918-331-1091
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3040207PE0004X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100100690BMedicaid
OKP00265529OtherMEDICARE RAILROAD
OK$$$$$$$$$OtherTRICARE
OK100100690BMedicaid
OKF34571Medicare UPIN
OKP00265529OtherMEDICARE RAILROAD