Provider Demographics
NPI:1922071091
Name:TAUB, MORRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MORRIS
Middle Name:
Last Name:TAUB
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:P O BOX 6037
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90734-6037
Mailing Address - Country:US
Mailing Address - Phone:310-832-1152
Mailing Address - Fax:310-832-3398
Practice Address - Street 1:658 W 7TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3118
Practice Address - Country:US
Practice Address - Phone:310-832-1152
Practice Address - Fax:310-832-3398
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27806207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G278061Medicaid
CAA43503Medicare UPIN
CA00G278061Medicaid