Provider Demographics
NPI:1871571018
Name:MORGAN, PAUL A (PAC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:MORGAN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7455 W WASHINGTON AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-4356
Mailing Address - Country:US
Mailing Address - Phone:702-878-0393
Mailing Address - Fax:
Practice Address - Street 1:1505 WIGWAM PKWY STE 330
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-8195
Practice Address - Country:US
Practice Address - Phone:702-878-0393
Practice Address - Fax:702-258-3777
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV393363AS0400X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1871571018Medicaid
NVV112831Medicare PIN
NV1871571018Medicaid