Provider Demographics
NPI:1750543054
Name:MORIN, DOUGLAS J (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:J
Last Name:MORIN
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 1:721 WEST 6TH
Mailing Address - Street 2:
Mailing Address - City:RED CLOUD
Mailing Address - State:NE
Mailing Address - Zip Code:68970
Mailing Address - Country:US
Mailing Address - Phone:402-746-5614
Mailing Address - Fax:402-746-5684
Practice Address - Street 1:721 WEST 6TH
Practice Address - Street 2:
Practice Address - City:RED CLOUD
Practice Address - State:NE
Practice Address - Zip Code:68970
Practice Address - Country:US
Practice Address - Phone:402-746-5614
Practice Address - Fax:402-746-5684
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5776207L00000X
NE5766207L00000X
NE25466208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology