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NPI Code Detail

MEDICARE: JACOB MORRILL PA-C

MEDICARE: JACOB MORRILL PA-C
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
1363A00000XPhysician Assistant055.0031345VT

General Provider Information

NPI Number : 1407386634
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB MORRILL PA-C
Provider Business Mailing Address
First Line : 119 JERICHO RD
Second Line :
City : ESSEX JUNCTION
State : VT
Zip : 05452-2745
Country : US
Telephone Number : 802-355-2314
Fax Number :
Provider Business Practice Location Address
First Line : 26 CANADA ST
Second Line :
City : SWANTON
State : VT
Zip : 05488-1335
Country : US
Telephone Number : 802-868-2454
Fax Number : 802-868-2461
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2017
Last Update Date : 06/20/2017

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