Healthcare Provider Details

I. General information

NPI: 1245281005
Provider Name (Legal Business Name): WILLIAM PHILIP MORRISSETTE III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15769 WC MAIN ST
MIDLOTHIAN VA
23113-7327
US

IV. Provider business mailing address

15769 WC MAIN ST
MIDLOTHIAN VA
23113-7327
US

V. Phone/Fax

Practice location:
  • Phone: 804-419-9701
  • Fax: 804-378-9143
Mailing address:
  • Phone: 804-419-9701
  • Fax: 804-378-9143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101030146
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: