Healthcare Provider Details

I. General information

NPI: 1093735037
Provider Name (Legal Business Name): GLENN JOSEPH MORRISON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 LUSITANA ST SUITE 904
HONOLULU HI
96813-2421
US

IV. Provider business mailing address

1380 LUSITANA ST SUITE 904
HONOLULU HI
96813-2421
US

V. Phone/Fax

Practice location:
  • Phone: 808-942-0800
  • Fax: 808-599-8801
Mailing address:
  • Phone: 808-942-0800
  • Fax: 808-599-8801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD11231
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: