Provider Demographics
NPI:1962704759
Name:MORGAN, TIMOTHY WAGNER JR
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:WAGNER
Last Name:MORGAN
Suffix:JR
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 1:200 OKLAHOMA AVE
Mailing Address - Street 2:POST IMMUNIZATIONS TEAM
Mailing Address - City:FORT LEONARD WOOD
Mailing Address - State:MO
Mailing Address - Zip Code:65473-8931
Mailing Address - Country:US
Mailing Address - Phone:573-596-1682
Mailing Address - Fax:
Practice Address - Street 1:200 OKLAHOMA AVE
Practice Address - Street 2:POST IMMUNIZATIONS TEAM
Practice Address - City:FORT LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65473-8931
Practice Address - Country:US
Practice Address - Phone:573-596-1682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QI0000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyImmunology