Healthcare Provider Details

I. General information

NPI: 1417256447
Provider Name (Legal Business Name): YAVAPAI SURGICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 AINSWORTH DR SUITE A
PRESCOTT AZ
86301-1612
US

IV. Provider business mailing address

810 AINSWORTH DR SUITE A
PRESCOTT AZ
86301-1612
US

V. Phone/Fax

Practice location:
  • Phone: 928-776-1994
  • Fax: 928-776-9917
Mailing address:
  • Phone: 928-776-1994
  • Fax: 928-776-9917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number12993A
License Number StateAZ

VIII. Authorized Official

Name: DR. CLIFFORD MICHAEL MORGAN
Title or Position: OWNER
Credential: MD
Phone: 928-776-1994