Provider Demographics
NPI:1912261074
Name:KIZZAR, MORGAN JOHONN (DPM)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:JOHONN
Last Name:KIZZAR
Suffix:
Gender:M
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:PO BOX 576
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81215-0576
Mailing Address - Country:US
Mailing Address - Phone:719-275-1037
Mailing Address - Fax:877-807-4835
Practice Address - Street 1:604 S 9TH ST
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-4910
Practice Address - Country:US
Practice Address - Phone:719-275-1037
Practice Address - Fax:877-807-4835
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000747213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery