Provider Demographics
NPI:1063491918
Name:MORSE, MARC JENNINGS (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:JENNINGS
Last Name:MORSE
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 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2701 OCEAN PARK BLVD STE 130
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405
Practice Address - Country:US
Practice Address - Phone:310-450-1200
Practice Address - Fax:310-450-8830
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG162875207Q00000X
UT6576420-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1063491918OtherNPI #
CO4653326OtherAETNA
CO84136530206OtherPACIFICARE PPO
UT942854057067Medicaid
CO01319425Medicaid
CO04020541Medicaid
1215981634OtherGROUP NPI #
CO276003OtherCIGNA
CO84136530203OtherPACIFICAE
COMO103038OtherANTHEM BCBS
CTRO103008OtherGROUP ANTHEM BCBS
CO841365302018OtherRKY MTN HMO
COMO103038OtherANTHEM BCBS
CO84136530203OtherPACIFICAE
F70856Medicare UPIN
COC189508Medicare ID - Type UnspecifiedGROUP MEDICARE
UT000060799Medicare PIN