Provider Demographics
NPI:1952628463
Name:MORGAN, JEROME GRAYSON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:GRAYSON
Last Name:MORGAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 MELVILLE SQ
Mailing Address - Street 2:302
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-4555
Mailing Address - Country:US
Mailing Address - Phone:415-306-2595
Mailing Address - Fax:
Practice Address - Street 1:1205 MELVILLE SQ
Practice Address - Street 2:302
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-4555
Practice Address - Country:US
Practice Address - Phone:415-306-2595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC26488208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology