Provider Demographics
NPI:1891806295
Name:MORGAN, JESSICA A (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:BERGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1524 NW KINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-2134
Mailing Address - Country:US
Mailing Address - Phone:801-910-0380
Mailing Address - Fax:541-278-8376
Practice Address - Street 1:929 SW SIMPSON AVENUE
Practice Address - Street 2:SUITE 300
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702
Practice Address - Country:US
Practice Address - Phone:541-389-7741
Practice Address - Fax:541-278-8376
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5071259-1205207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870526286OtherHUMANA
UT870526286OtherGREAT WEST
UT870526286JESOtherEMIA
UT73728OtherPEHP
UTTPRA07821OtherMOLINA
UT870526286OtherFIRST HEALTH
UT50112591201001OtherBLUE CROSS
UT870526286OtherPHCS
UT870526286OtherCCN
UTP00008435OtherRR MEDICARE
UT0101928OtherUHC
UT870526286OtherMAILHANDLERS
UTQM0000067482OtherALTIUS
UT870526286OtherBEECH STREET
UT107011317102OtherIHC
UT2122373OtherCIGNA
UT7306494OtherAETNA
UTH81087Medicare UPIN
UT870526286OtherGREAT WEST