Healthcare Provider Details

I. General information

NPI: 1265805568
Provider Name (Legal Business Name): DR. DOUGLAS W. MORRELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 E 11TH ST
RUSHVILLE IN
46173-1319
US

IV. Provider business mailing address

606 E 11TH ST
RUSHVILLE IN
46173-1319
US

V. Phone/Fax

Practice location:
  • Phone: 765-932-2965
  • Fax: 765-932-4859
Mailing address:
  • Phone: 765-932-2965
  • Fax: 765-932-4859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01024901A
License Number StateIN

VIII. Authorized Official

Name: DR. DOUGLAS W. MORRELL
Title or Position: OWNER
Credential: M.D.
Phone: 765-932-2965