Provider Demographics
NPI:1740386432
Name:MORGENSTERN, JOHN CARL (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CARL
Last Name:MORGENSTERN
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 1:415 6TH STREET
Mailing Address - Street 2:ATTN: PHYSICIAN SERVICES
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2434
Mailing Address - Country:US
Mailing Address - Phone:208-750-7462
Mailing Address - Fax:208-750-7467
Practice Address - Street 1:415 6TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501
Practice Address - Country:US
Practice Address - Phone:208-743-3998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-11337207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1740386432Medicaid
000000049730OtherANTHEM INSURANCE
KY64271950Medicaid
KY64271950Medicaid