Healthcare Provider Details

I. General information

NPI: 1003499476
Provider Name (Legal Business Name): CALLIE LORRAINE MORLOCK DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 S 1100 E STE 210
SALT LAKE CITY UT
84102-1580
US

IV. Provider business mailing address

1600 23RD AVE
GREELEY CO
80634-6070
US

V. Phone/Fax

Practice location:
  • Phone: 801-505-5277
  • Fax:
Mailing address:
  • Phone: 970-810-2847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number13818943-0501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: