MEDICARE: MORRISON MURPHY BROAS LLC

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
1	122300000X	Dentist	0401007138	VA

General Provider Information

NPI Number	:	1346505088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORRISON MURPHY BROAS LLC

Provider Business Mailing Address
First Line	:	4009 MAIN STREET
Second Line	:
City	:	CHINCOTEAGUE
State	:	VA
Zip	:	23336
Country	:	US
Telephone Number	:	757-336-1260
Fax Number	:

Provider Business Practice Location Address
First Line	:	4009 MAIN ST
Second Line	:
City	:	CHINCOTEAGUE
State	:	VA
Zip	:	23336-2406
Country	:	US
Telephone Number	:	757-336-1260
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. ROBERT F MORRISON JR.
Credential	:	D.M.D.
Telephone Number	:	757-220-0330

Provider Enumeration Date	:	07/09/2012
Last Update Date	:	07/09/2012

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