Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | OS004259L | PA |
NPI | 1255449476 |
---|---|
Provider Name | Dr. Bruce S Morrison |
First Address | Huntingdon Valley, PA 19006-3518 |
Second Address | Huntingdon Valley, PA 19006-3518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0421883000 | INDEPENDENCE BLUE CROSS (01) | PA |
119371 | HIGHMARK (01) | PA |
D98667 | (02) | PA |