Provider Demographics
NPI:1336213800
Name:MORGAN, ROGER (MD, PHD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:MORGAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1354
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72303-1354
Mailing Address - Country:US
Mailing Address - Phone:901-335-9394
Mailing Address - Fax:870-732-5820
Practice Address - Street 1:116 W TYLER AVE
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-4221
Practice Address - Country:US
Practice Address - Phone:901-335-9394
Practice Address - Fax:901-328-1888
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR95-7P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5S935OtherBLUE CROSS
AR126677719Medicaid
AR5S935Medicare PIN
AR126677719Medicaid