Provider Demographics
NPI:1568090538
Name:VAN AMEYDE, MORGAN (DO)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:VAN AMEYDE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 N DESERT BLVD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-2441
Mailing Address - Country:US
Mailing Address - Phone:915-521-2210
Mailing Address - Fax:915-521-7554
Practice Address - Street 1:6600 N DESERT BLVD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-2441
Practice Address - Country:US
Practice Address - Phone:915-521-2210
Practice Address - Fax:915-521-7554
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine