=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316449457
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GERALD MORLEY PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2018
-----------------------------------------------------
Last Update Date | 06/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4600 LAKE ROAD AVE
-----------------------------------------------------
City | ROBBINSDALE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55422-1800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-522-2222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8524 HOPEWOOD LN N
-----------------------------------------------------
City | NEW HOPE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55427-1146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-587-3260
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NEUROLOGIST
-----------------------------------------------------
Name | GERALD KENT MORLEY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 763-587-3260
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | 18280
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------