Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | M6842 | ID |
NPI | 1215975164 |
---|---|
Provider Name | James H Morland |
First Address | Meridian, ID 83642-9005 |
Second Address | Meridian, ID 83642-9005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 29/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000010161457 | BLUE SHIELD (01) | ID |
308275 | ALTIUS (01) | ID |
8N143 | BLUE CROSS (01) | |
F50111 | (02) |