Provider Demographics
NPI:1730189044
Name:MORGAN, WILLIAM TYRE (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:TYRE
Last Name:MORGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 561600
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32956
Mailing Address - Country:US
Mailing Address - Phone:321-434-4600
Mailing Address - Fax:321-434-4642
Practice Address - Street 1:8245 DEVEREUX DRIVE
Practice Address - Street 2:ADMINISTRATIVE OFFICE
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940
Practice Address - Country:US
Practice Address - Phone:321-434-4600
Practice Address - Fax:321-434-4642
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42682207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067673000Medicaid
05476VMedicare PIN
FL067673000Medicaid
D51311Medicare PIN