Healthcare Provider Details

I. General information

NPI: 1265461784
Provider Name (Legal Business Name): JONATHAN MORSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 CAMBRIA WAY
SANTA ROSA CA
95403-7847
US

IV. Provider business mailing address

178 CAMBRIA WAY
SANTA ROSA CA
95403-7847
US

V. Phone/Fax

Practice location:
  • Phone: 707-888-9682
  • Fax:
Mailing address:
  • Phone: 707-888-9682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG81437
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG81437
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberG81437
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: