Provider Demographics
NPI:1942233572
Name:MORGAN, LORI J (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:J
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MD
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 5299
Mailing Address - Street 2:MS: 315-J1-TRM
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98415-0299
Mailing Address - Country:US
Mailing Address - Phone:253-403-7537
Mailing Address - Fax:253-403-7539
Practice Address - Street 1:315 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:MS: 315-J1-TRM
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4234
Practice Address - Country:US
Practice Address - Phone:253-403-7537
Practice Address - Fax:153-403-7539
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038504208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8253411Medicaid
WA8930053OtherCRIME VICTIMS COMP PIN
WA179337OtherDEPT OF L&I PIN
WAMI8160OtherREGENCE PIN
WAP00172881OtherRR MEDICARE PIN
WAB009OtherTRICARE PIN
WAMI8160OtherREGENCE PIN
WAP00172881OtherRR MEDICARE PIN