Provider Demographics
NPI:1720178007
Name:MORLAND, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MORLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:GALVA
Mailing Address - State:IL
Mailing Address - Zip Code:61434-1784
Mailing Address - Country:US
Mailing Address - Phone:309-932-3800
Mailing Address - Fax:309-932-2910
Practice Address - Street 1:120 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:GALVA
Practice Address - State:IL
Practice Address - Zip Code:61434-1784
Practice Address - Country:US
Practice Address - Phone:309-932-3800
Practice Address - Fax:309-932-2910
Is Sole Proprietor?:No
Enumeration Date:2006-10-15
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-001194363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL970018248Medicare ID - Type UnspecifiedRR INDIVIDUAL #
ILS92418Medicare UPIN
ILCB6569Medicare ID - Type UnspecifiedRR GROUP #
K52340Medicare PIN
IL589020Medicare ID - Type UnspecifiedINDIVIDUAL #
IL592418Medicare ID - Type UnspecifiedGROUP #