Provider Demographics
NPI:1295701498
Name:MORGAN, GARY LON JR (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:LON
Last Name:MORGAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-788-4664
Mailing Address - Fax:336-788-0753
Practice Address - Street 1:5010 PETERS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-7276
Practice Address - Country:US
Practice Address - Phone:336-788-4664
Practice Address - Fax:336-788-0753
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9501018207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8960721Medicaid
NC8960721Medicaid
NC2214180CMedicare PIN
G07859Medicare UPIN
NC2214180AMedicare ID - Type Unspecified