Provider Demographics
NPI:1962403154
Name:MORGAN, MATT (MD)
Entity type:Individual
Prefix:
First Name:MATT
Middle Name:
Last Name:MORGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7945 W SAHARA AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7908
Mailing Address - Country:US
Mailing Address - Phone:702-935-2000
Mailing Address - Fax:877-219-5342
Practice Address - Street 1:7945 W SAHARA AVE STE 108
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7908
Practice Address - Country:US
Practice Address - Phone:702-935-2000
Practice Address - Fax:877-219-5342
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV18568207K00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV18568OtherSTATE LICENCE
TXL5474OtherSTATE LICENCE
TX8B4788Medicare ID - Type Unspecified
TX169658501Medicaid