Provider Demographics
NPI:1255449476
Name:MORRISON, BRUCE S (DO)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:S
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 1:1800 BYBERRY RD
Mailing Address - Street 2:MASON MILLS PARK II SUITE 703
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-3518
Mailing Address - Country:US
Mailing Address - Phone:215-947-9131
Mailing Address - Fax:215-947-7194
Practice Address - Street 1:1800 BYBERRY RD
Practice Address - Street 2:MASON MILLS PARK II SUITE 703
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-3518
Practice Address - Country:US
Practice Address - Phone:215-947-9131
Practice Address - Fax:215-947-7194
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004259L207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA119371OtherHIGHMARK
PA0421883000OtherINDEPENDENCE BLUE CROSS
PAD98667Medicare UPIN
PA119371Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #