Provider Demographics
NPI:1376779413
Name:MORGAN, CLINTON R (MD)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:R
Last Name:MORGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1250 IDAHO STREET
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501
Mailing Address - Country:US
Mailing Address - Phone:208-743-7427
Mailing Address - Fax:208-743-7421
Practice Address - Street 1:1250 IDAHO ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1965
Practice Address - Country:US
Practice Address - Phone:208-743-7427
Practice Address - Fax:208-743-7421
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD156966207R00000X
NH15628207R00000X
IDM-12810207RH0003X
WAMD.MD.60535666207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine