Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | 10984 | ND |
N | 2086S0105X | Surgery of the Hand | L7058 | TX |
N | 2086S0105X | Surgery of the Hand | PT10984 | ND |
NPI | 1215087713 |
---|---|
Provider Name | Blake Alan Morrison |
First Address | Fargo, ND 58103-5800 |
Second Address | Fargo, ND 58103-5800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 13/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0037MQ | BCBS GROUP (P.A.) NO. (01) | TX |
1726390 | (05) | TX |
8S2450 | BLUE CROSS INDIVIDUAL NO. (01) | TX |
I20809 | (02) | TX |
Y21509 | (02) | TX |