Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 2301009577 | MI |
NPI | 1164653788 |
---|---|
Provider Name | Dr. Jon Dale Morey |
First Address | Flushing, MI 48433-2138 |
Second Address | Flushing, MI 48433-2138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2009 |
Last Update Date | 30/07/2009 |