Healthcare Provider Details

I. General information

NPI: 1063589687
Provider Name (Legal Business Name): DAVID C. MORRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 E DIVISION ST
MOUNT VERNON WA
98274-4134
US

IV. Provider business mailing address

1315 E DIVISION ST
MOUNT VERNON WA
98274-4134
US

V. Phone/Fax

Practice location:
  • Phone: 360-424-8951
  • Fax: 360-424-8953
Mailing address:
  • Phone: 360-424-8951
  • Fax: 360-424-8953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD00026375
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: