Provider Demographics
NPI:1629271820
Name:MORRISON, ROYCE ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROYCE
Middle Name:ALAN
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 1:1101 A ST
Mailing Address - Street 2:APARTMENT 708
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-5007
Mailing Address - Country:US
Mailing Address - Phone:206-605-9858
Mailing Address - Fax:
Practice Address - Street 1:3615 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-7921
Practice Address - Country:US
Practice Address - Phone:253-593-5304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00014630207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1035203Medicaid
WA1035203Medicaid