Provider Demographics
NPI:1205826880
Name:MORGAN, DONALD LYNN (DO)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:LYNN
Last Name:MORGAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1739 BEVERLY AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3593
Mailing Address - Country:US
Mailing Address - Phone:928-692-3456
Mailing Address - Fax:692-692-7071
Practice Address - Street 1:1739 BEVERLY AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3593
Practice Address - Country:US
Practice Address - Phone:928-692-3456
Practice Address - Fax:692-692-7071
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ3398207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ462474Medicaid
AZ3398OtherLICENSE
AZAM2305200OtherDEA
AZ3398OtherLICENSE
AZ26386Medicare ID - Type Unspecified