Healthcare Provider Details

I. General information

NPI: 1033354915
Provider Name (Legal Business Name): SCOTT PATRICK MORRILL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 01/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6052 W STATE ST
BOISE ID
83703-2739
US

IV. Provider business mailing address

6052 W STATE ST
BOISE ID
83703-2739
US

V. Phone/Fax

Practice location:
  • Phone: 208-947-1947
  • Fax: 208-947-1945
Mailing address:
  • Phone: 208-947-1947
  • Fax: 208-947-1945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 786
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: