Provider Demographics
NPI:1700996089
Name:MORRIS, TED J (CRNA)
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:J
Last Name:MORRIS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 W 3420 N
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-8805
Mailing Address - Country:US
Mailing Address - Phone:801-765-0670
Mailing Address - Fax:
Practice Address - Street 1:331 N 400 W
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-1913
Practice Address - Country:US
Practice Address - Phone:801-765-0670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT0201025-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT693897OtherDESERET MUTUAL
UTQM0000054865OtherALTIUS
UTPRA06689OtherMOLINA
UT66117OtherPEHP
UT15302OtherHEALTHY U
UT107009149103OtherIHC
UT693897OtherDESERET MUTUAL