Healthcare Provider Details

I. General information

NPI: 1235172412
Provider Name (Legal Business Name): JOHN W. MORRISON, JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1399 WEIMER RD SUITE 300
TAOS NM
87571-6340
US

IV. Provider business mailing address

8801 HORIZON BLVD NE SUITE 360
ALBUQUERQUE NM
87113-1533
US

V. Phone/Fax

Practice location:
  • Phone: 505-758-0621
  • Fax: 505-758-0622
Mailing address:
  • Phone: 505-246-2622
  • Fax: 505-213-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number92-264
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: