Provider Demographics
NPI:1205018769
Name:MORRISON MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:MORRISON MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-651-1690
Mailing Address - Street 1:260 NW 183RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4462
Mailing Address - Country:US
Mailing Address - Phone:305-651-1690
Mailing Address - Fax:305-652-4457
Practice Address - Street 1:260 NW 183RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-4462
Practice Address - Country:US
Practice Address - Phone:305-651-1690
Practice Address - Fax:305-652-4457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 51852207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07745OtherBLUE CROSS BLUE SHIELD
FLE21415Medicare UPIN
FL07745ZMedicare PIN