Healthcare Provider Details

I. General information

NPI: 1740386432
Provider Name (Legal Business Name): JOHN CARL MORGENSTERN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 6TH ST
LEWISTON ID
83501
US

IV. Provider business mailing address

415 6TH STREET ATTN: PHYSICIAN SERVICES
LEWISTON ID
83501-2434
US

V. Phone/Fax

Practice location:
  • Phone: 208-743-3998
  • Fax:
Mailing address:
  • Phone: 208-750-7462
  • Fax: 208-750-7467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberM-11337
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: