Provider Demographics
NPI:1558473025
Name:CLYDE MCMORRIS MD PA
Entity Type:Organization
Organization Name:CLYDE MCMORRIS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMORRIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:713-655-0528
Mailing Address - Street 1:1315 ST JOSEPH PKWY
Mailing Address - Street 2:1701
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8233
Mailing Address - Country:US
Mailing Address - Phone:713-655-0528
Mailing Address - Fax:713-655-0046
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00218XMedicare PIN