Provider Demographics
NPI:1396003455
Name:LIDDELL, MORGAN BIRRELL (MD)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:BIRRELL
Last Name:LIDDELL
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 1:122 1ST AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4871
Mailing Address - Country:US
Mailing Address - Phone:907-459-3800
Mailing Address - Fax:907-459-3810
Practice Address - Street 1:122 1ST AVE STE 400
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4871
Practice Address - Country:US
Practice Address - Phone:907-459-3800
Practice Address - Fax:907-459-3810
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1210252084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry