Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CHIA748 | ID |
NPI | 1558480699 |
---|---|
Provider Name | Dr. Morgan G Barkdull |
First Address | Driggs, ID 83422-0526 |
Second Address | Driggs, ID 83422 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U65612 | (02) | ID |