Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | ||
Y | 222Z00000X | Podiatrist |
NPI | 1023323847 |
---|---|
Provider Name | John M Morrell |
First Address | Clackamas, OR 97015-7708 |
Second Address | Clackamas, OR 97015-7708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2010 |
Last Update Date | 17/08/2010 |