Provider Demographics
NPI:1366790479
Name:SILLDORFF, MORGAN DANA (MD)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:DANA
Last Name:SILLDORFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:310 SANTA FE DR STE 112
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5123
Mailing Address - Country:US
Mailing Address - Phone:760-642-7007
Mailing Address - Fax:760-230-1453
Practice Address - Street 1:310 SANTA FE DR STE 112
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5123
Practice Address - Country:US
Practice Address - Phone:760-642-7007
Practice Address - Fax:760-230-1453
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA127365207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA64116Medicare PIN