Basic Information
| Provider Information | |||||||||
| NPI: | 1376779413 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORGAN | ||||||||
| FirstName: | CLINTON | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1250 IDAHO STREET | ||||||||
| Address2: | |||||||||
| City: | LEWISTON | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087437427 | ||||||||
| FaxNumber: | 2087437421 | ||||||||
| Practice Location | |||||||||
| Address1: | 1250 IDAHO ST | ||||||||
| Address2: | |||||||||
| City: | LEWISTON | ||||||||
| State: | ID | ||||||||
| PostalCode: | 835011965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087437427 | ||||||||
| FaxNumber: | 2087437421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2009 | ||||||||
| LastUpdateDate: | 10/20/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD156966 | OR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 15628 | NH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | M-12810 | ID | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | MD.MD.60535666 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.