Provider Demographics
NPI:1215992730
Name:MORGAN, CLIFFORD MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:MICHAEL
Last Name:MORGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10880
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0880
Mailing Address - Country:US
Mailing Address - Phone:928-759-5987
Mailing Address - Fax:928-458-2039
Practice Address - Street 1:810 AINSWORTH DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1612
Practice Address - Country:US
Practice Address - Phone:928-776-1994
Practice Address - Fax:928-776-9917
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12993208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0334980OtherBLUE CROSS BLUE SHIELD
AZ238867OtherAHCCCS
AZAZ0334980OtherBLUE CROSS BLUE SHIELD
AZMD12993AMedicare ID - Type Unspecified
AZ020004143Medicare ID - Type UnspecifiedRAILROAD MEDICARE