Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DS003952 | TN |
NPI | 1003097627 |
---|---|
Provider Name | Dr. Mark E Morison |
First Address | Kingsport, TN 37660-4947 |
Second Address | Kingsport, TN 37660-4947 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2007 |
Last Update Date | 26/11/2007 |