Provider Demographics
NPI:1982112504
Name:MORGAN, PORTER
Entity Type:Individual
Prefix:
First Name:PORTER
Middle Name:
Last Name:MORGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10153 S DELSEY CV
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-7108
Mailing Address - Country:US
Mailing Address - Phone:801-949-0155
Mailing Address - Fax:
Practice Address - Street 1:9678 S 700 E STE 102
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-3593
Practice Address - Country:US
Practice Address - Phone:801-576-6444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker