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NPI Code Detail

MEDICARE: DR. CHARLES REESE MORRISON M.D.

MEDICARE: DR. CHARLES REESE MORRISON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1173000000XLegal Medicine5525050-1205UT
2207Q00000XFamily Medicine Physician5523050-1205UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083669204
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES REESE MORRISON M.D.
Provider Business Mailing Address
First Line : PO BOX 27128
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84127-0128
Country : US
Telephone Number : 801-491-6482
Fax Number :
Provider Business Practice Location Address
First Line : 1665 BONANZA DR
Second Line :
City : PARK CITY
State : UT
Zip : 84060-5127
Country : US
Telephone Number : 435-649-7640
Fax Number : 435-649-1365
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2006
Last Update Date : 08/31/2012

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