Healthcare Provider Details

I. General information

NPI: 1215013628
Provider Name (Legal Business Name): SUSAN WENLIN MORRISON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 E HAMMER LN STE A
STOCKTON CA
95210-4124
US

IV. Provider business mailing address

PO BOX 779
STOCKTON CA
95201-0779
US

V. Phone/Fax

Practice location:
  • Phone: 209-373-2814
  • Fax: 209-373-2873
Mailing address:
  • Phone: 209-373-2800
  • Fax: 209-373-2873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA77045
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: