Provider Demographics
NPI:1356352298
Name:MORRON, CLYDE R III (PA)
Entity type:Individual
Prefix:
First Name:CLYDE
Middle Name:R
Last Name:MORRON
Suffix:III
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1700 MURCHISON DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2931
Mailing Address - Country:US
Mailing Address - Phone:915-544-3254
Mailing Address - Fax:915-544-1203
Practice Address - Street 1:1700 MURCHISON DR
Practice Address - Street 2:SUITE 215
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2931
Practice Address - Country:US
Practice Address - Phone:915-544-3254
Practice Address - Fax:915-544-1203
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2011-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA04181363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N9799OtherBC/BS OF TEXAS