Provider Demographics
NPI:1528010519
Name:MCMORRIS, CLYDE JR
Entity Type:Individual
Prefix:
First Name:CLYDE
Middle Name:
Last Name:MCMORRIS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:CLYDE
Other - Middle Name:
Other - Last Name:MCMORRIS
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD PA
Mailing Address - Street 1:PO BOX 14908
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77347-4908
Mailing Address - Country:US
Mailing Address - Phone:281-934-1000
Mailing Address - Fax:281-934-1020
Practice Address - Street 1:1315 ST JOSEPH PKWY
Practice Address - Street 2:1701
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8233
Practice Address - Country:US
Practice Address - Phone:713-655-0528
Practice Address - Fax:713-655-0046
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5621207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8C1942Medicare PIN