Provider Demographics
NPI:1356335111
Name:MORGAN, RANDALL C (MD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:C
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 1:2750 BAHIA VISTA STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239
Mailing Address - Country:US
Mailing Address - Phone:941-951-2663
Mailing Address - Fax:941-360-2233
Practice Address - Street 1:2750 BAHIA VISTA STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239
Practice Address - Country:US
Practice Address - Phone:941-951-2663
Practice Address - Fax:941-360-2233
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86466207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL201891461OtherTAX ID
FL64050OtherBCBS
FL272196100Medicaid
FL201891461OtherTAX ID
FL64050OtherBCBS
FL272196100Medicaid