Healthcare Provider Details

I. General information

NPI: 1508836099
Provider Name (Legal Business Name): MARSHALL MORRISON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 02/23/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 INDUSTRIAL AVE
AZLE TX
76020-2901
US

IV. Provider business mailing address

141 INDUSTRIAL AVE
AZLE TX
76020-2901
US

V. Phone/Fax

Practice location:
  • Phone: 817-270-3132
  • Fax:
Mailing address:
  • Phone: 817-270-3132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG5405
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: