Provider Demographics
NPI:1376557371
Name:MORNING STAR OBSTETRICS & GYNECOLOGY PC
Entity Type:Organization
Organization Name:MORNING STAR OBSTETRICS & GYNECOLOGY PC
Other - Org Name:MORNING STAR OBSTETRICS AND GYNECOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-355-8525
Mailing Address - Street 1:3499 S MERCY RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-0437
Mailing Address - Country:US
Mailing Address - Phone:480-355-8525
Mailing Address - Fax:480-355-3115
Practice Address - Street 1:3499 S MERCY RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-0437
Practice Address - Country:US
Practice Address - Phone:480-355-8525
Practice Address - Fax:480-355-3115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ316526Medicaid
AZ316526Medicaid