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NPI Code Detail

MEDICARE: DR. JEFFERY C MORISSETTE D.O.

MEDICARE: DR. JEFFERY C MORISSETTE D.O.
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
12085R0202XDiagnostic Radiology Physician1961AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21Z7086OTHERAZHEALTH NET OF AZ
3AZ0221810OTHERAZBCBSAZ

General Provider Information

NPI Number : 1821060864
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFERY C MORISSETTE D.O.
Provider Business Mailing Address
First Line : PO BOX 27340
Second Line :
City : PHOENIX
State : AZ
Zip : 85061-7340
Country : US
Telephone Number : 602-943-9200
Fax Number : 602-216-3000
Provider Business Practice Location Address
First Line : 19829 N 27TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85027-4001
Country : US
Telephone Number : 623-879-5720
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2006
Last Update Date : 05/14/2008

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