Provider Demographics
NPI:1831290949
Name:MORGAN, BARBARA D (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:D
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:DALE
Other - Last Name:MARTYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-381-2222
Mailing Address - Fax:208-882-7006
Practice Address - Street 1:619 S WASHINGTON
Practice Address - Street 2:SUITE 201
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843
Practice Address - Country:US
Practice Address - Phone:208-882-1777
Practice Address - Fax:208-882-7006
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM62192084N0400X
WA316052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002706700Medicaid
WA8146342Medicaid
WA8146342Medicaid
B54858Medicare UPIN
ID1127393Medicare ID - Type Unspecified