Provider Demographics
NPI:1912092479
Name:MORRISON, ROSEANN (DPM)
Entity Type:Individual
Prefix:
First Name:ROSEANN
Middle Name:
Last Name:MORRISON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5212 W. BROAD ST., STE F
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228
Mailing Address - Country:US
Mailing Address - Phone:614-870-0000
Mailing Address - Fax:614-870-2225
Practice Address - Street 1:5212 W. BROAD ST., STE F
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228
Practice Address - Country:US
Practice Address - Phone:614-870-0000
Practice Address - Fax:614-870-2225
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002804213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0946061Medicaid
OH0946061Medicaid
OHU34852Medicare UPIN