Provider Demographics
NPI:1770160558
Name:MORGAN, JUSTIN MONROE (MD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:MONROE
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:PO BOX 589
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:AK
Mailing Address - Zip Code:99833-0589
Mailing Address - Country:US
Mailing Address - Phone:907-772-4291
Mailing Address - Fax:907-772-3085
Practice Address - Street 1:PO BOX 589
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:AK
Practice Address - Zip Code:99833-0589
Practice Address - Country:US
Practice Address - Phone:907-772-4291
Practice Address - Fax:907-772-3085
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AK224624207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program