Provider Demographics
NPI:1922219187
Name:MORGAN, CLARK R (MD)
Entity Type:Individual
Prefix:
First Name:CLARK
Middle Name:R
Last Name:MORGAN
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 1:9230 CLIFFMERE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-3331
Mailing Address - Country:US
Mailing Address - Phone:469-774-0454
Mailing Address - Fax:
Practice Address - Street 1:9230 CLIFFMERE DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-3331
Practice Address - Country:US
Practice Address - Phone:469-774-0454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-26
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1786207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP1-0026364OtherINSTITUTIONAL PERMIT