Healthcare Provider Details

I. General information

NPI: 1316943996
Provider Name (Legal Business Name): PETER E MORNINGSTAR MC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 06/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 NORTH ST
PRESQUE ISLE ME
04769-2291
US

IV. Provider business mailing address

23 NORTH ST
PRESQUE ISLE ME
04769-2291
US

V. Phone/Fax

Practice location:
  • Phone: 207-764-5437
  • Fax: 207-764-4760
Mailing address:
  • Phone: 207-764-5437
  • Fax: 207-764-4760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number016420
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: