Healthcare Provider Details

I. General information

NPI: 1639485246
Provider Name (Legal Business Name): MORGAN YOST DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2010
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 HOSPITAL WAY
POCATELLO ID
83201-5175
US

IV. Provider business mailing address

777 HOSPITAL WAY
POCATELLO ID
83201-5175
US

V. Phone/Fax

Practice location:
  • Phone: 208-239-1920
  • Fax: 208-239-3754
Mailing address:
  • Phone: 208-239-1920
  • Fax: 208-239-3754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2010019812
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberO-0778
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number2010019812
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: