Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | JM005697 | MI |
N | 222Z00000X | Podiatrist | JM005697 | MI |
Y | 213ES0103X | Foot & Ankle Surgery | 5901002026 | MI |
NPI | 1093701203 |
---|---|
Provider Name | Jeffrey R Morin |
First Address | Port Huron, MI 48060-4463 |
Second Address | East Lansing, MI 48823-5353 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2005 |
Last Update Date | 03/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1093701203 | (05) | MI |
4317700 | (05) | MI |
U85402 | (02) |