Provider Demographics
NPI:1457358962
Name:MORGAN, CHRISTIAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:M
Last Name:MORGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTIAN
Other - Middle Name:M
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:110 HOSPITAL LANE
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:WY
Mailing Address - Zip Code:83110-0579
Mailing Address - Country:US
Mailing Address - Phone:307-885-5852
Mailing Address - Fax:307-885-5889
Practice Address - Street 1:110 HOSPITAL LANE
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:WY
Practice Address - Zip Code:83110-0579
Practice Address - Country:US
Practice Address - Phone:307-885-5852
Practice Address - Fax:307-885-5889
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46590207Q00000X
WY8270A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN136615700Medicaid
MN136615700Medicaid
MN080013350Medicare PIN