Provider Demographics
NPI:1770804171
Name:MORGAN, CRAIG RYAN (DPM)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:RYAN
Last Name:MORGAN
Suffix:
Gender:U
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 10TH AVE APT 617
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-7419
Mailing Address - Country:US
Mailing Address - Phone:510-685-0322
Mailing Address - Fax:
Practice Address - Street 1:276 CHURCH AVE STE A
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2729
Practice Address - Country:US
Practice Address - Phone:619-427-0311
Practice Address - Fax:619-427-0327
Is Sole Proprietor?:No
Enumeration Date:2010-06-20
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5230213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00E5230Medicaid