Healthcare Provider Details

I. General information

NPI: 1558477802
Provider Name (Legal Business Name): DOUGLAS WAYNE MORRELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 11/11/2009
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:
Title or Position:
Credential:
Phone: