Provider Demographics
NPI:1427102573
Name:DRY CREEK MEDICAL GROUP
Entity type:Organization
Organization Name:DRY CREEK MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-297-7563
Mailing Address - Street 1:PO BOX 1920
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93613-1920
Mailing Address - Country:US
Mailing Address - Phone:559-297-7563
Mailing Address - Fax:559-297-5374
Practice Address - Street 1:7055 N MAPLE AVE STE 106
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-8012
Practice Address - Country:US
Practice Address - Phone:559-297-7563
Practice Address - Fax:559-297-5374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID
CA=========OtherTAX ID