Provider Demographics
NPI:1255064424
Name:MORGAN, TAVIN B (DPM)
Entity type:Individual
Prefix:MR
First Name:TAVIN
Middle Name:B
Last Name:MORGAN
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N CARSON ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-1216
Mailing Address - Country:US
Mailing Address - Phone:775-882-1441
Mailing Address - Fax:775-882-6844
Practice Address - Street 1:1801 N CARSON ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-1216
Practice Address - Country:US
Practice Address - Phone:775-882-1441
Practice Address - Fax:775-882-6844
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PASC007309213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program