Healthcare Provider Details

I. General information

NPI: 1083669204
Provider Name (Legal Business Name): CHARLES REESE MORRISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 BONANZA DR
PARK CITY UT
84060-5127
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 435-649-7640
  • Fax: 435-649-1365
Mailing address:
  • Phone: 801-491-6482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number5525050-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5523050-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: