Provider Demographics
NPI:1255350864
Name:MORGAN, JONATHAN M (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:M
Last Name:MORGAN
Suffix:
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 1:1330 S. FT. HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756
Mailing Address - Country:US
Mailing Address - Phone:727-441-3588
Mailing Address - Fax:727-461-1038
Practice Address - Street 1:1330 S. FT. HARRISON AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756
Practice Address - Country:US
Practice Address - Phone:727-441-3588
Practice Address - Fax:727-461-1038
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88962207Y00000X, 207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272894000Medicaid
FL16456OtherBLUE CROSS BLUE SHIELD
FL16456ZMedicare UPIN
FL16456ZMedicare PIN
FLP00269572Medicare PIN