Healthcare Provider Details

I. General information

NPI: 1013772680
Provider Name (Legal Business Name): DAVID MORRISON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4358 S BROADWAY
ENGLEWOOD CO
80113-5720
US

IV. Provider business mailing address

PO BOX 527
ENGLEWOOD CO
80151-0527
US

V. Phone/Fax

Practice location:
  • Phone: 720-877-0972
  • Fax:
Mailing address:
  • Phone: 720-877-0972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number12-095-0359
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: