Provider Demographics
NPI:1265695191
Name:MORRISON, PAUL EDWARD (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:EDWARD
Last Name:MORRISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:491 W BOURNE CIR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-3630
Mailing Address - Country:US
Mailing Address - Phone:801-939-9111
Mailing Address - Fax:801-939-9309
Practice Address - Street 1:491 W BOURNE CIR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-3630
Practice Address - Country:US
Practice Address - Phone:801-939-9111
Practice Address - Fax:801-939-9309
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-11050208000000X
UT9392142-1205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics