Provider Demographics
NPI:1922190875
Name:MORIN, JOSEPH RAOUL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:RAOUL
Last Name:MORIN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:517 LAKEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3453
Mailing Address - Country:US
Mailing Address - Phone:423-378-4708
Mailing Address - Fax:
Practice Address - Street 1:698 CLINCHFIELD ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3630
Practice Address - Country:US
Practice Address - Phone:423-378-6202
Practice Address - Fax:423-246-8907
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD119462080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3179615Medicaid
TNB03869Medicare UPIN