Provider Demographics
NPI:1629050588
Name:MORRISON, PAUL D (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:MORRISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:PO BOX 800
Mailing Address - Street 2:EASTERN STATE HOSPITAL
Mailing Address - City:MEDICAL LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99022-0800
Mailing Address - Country:US
Mailing Address - Phone:509-565-4000
Mailing Address - Fax:509-565-7015
Practice Address - Street 1:850 WEST MAPLE STREET
Practice Address - Street 2:EASTERN STATE HOSPITAL
Practice Address - City:MEDICAL LAKE
Practice Address - State:WA
Practice Address - Zip Code:99022-0800
Practice Address - Country:US
Practice Address - Phone:509-565-4000
Practice Address - Fax:509-565-7015
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD000313572084P0800X
IDM-63932084P0800X, 207R00000X
WAMD 00031357207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8421497Medicaid
WAI12140Medicare UPIN
WA8421497Medicaid