Provider Demographics
NPI:1114969102
Name:MORRISON, GEORGE (DO)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:MORRISON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17501 17TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7924
Mailing Address - Country:US
Mailing Address - Phone:949-263-8620
Mailing Address - Fax:949-263-1639
Practice Address - Street 1:3751 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3101
Practice Address - Country:US
Practice Address - Phone:949-263-8620
Practice Address - Fax:949-263-1639
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A47382085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00370152OtherRR MEDICARE
CAP00370152OtherRR MEDICARE
CAW20A4738MMedicare PIN