Provider Demographics
NPI:1851474944
Name:MORGAN, DAVID GARY SR (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GARY
Last Name:MORGAN
Suffix:SR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 GRANDVILLE ARCH
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23430-6150
Mailing Address - Country:US
Mailing Address - Phone:757-604-1733
Mailing Address - Fax:757-825-9658
Practice Address - Street 1:1618 HARDY CASH DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2400
Practice Address - Country:US
Practice Address - Phone:757-825-5783
Practice Address - Fax:757-825-9658
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80168213ES0103X
VA0103001007213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS480000129Medicaid
VA016584A51OtherMEDICARE PROVIDER ID
MS0125558Medicare ID - Type Unspecified
MS480000129Medicaid