Provider Demographics
NPI:1447258280
Name:MORRISON, DALE LEROY (MD)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:LEROY
Last Name:MORRISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3536 MENDOCINO AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3634
Mailing Address - Country:US
Mailing Address - Phone:707-525-6485
Mailing Address - Fax:707-463-8075
Practice Address - Street 1:244 HOSPITAL DR
Practice Address - Street 2:STE B
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4557
Practice Address - Country:US
Practice Address - Phone:707-463-8070
Practice Address - Fax:707-463-8075
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2012-02-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG23143207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G231430Medicaid
CAP00175066OtherRAILROAD MEDICARE
CA00G231430OtherBLUE SHIELD OF CALIFORNIA
CA00G231430Medicaid
CAA41871Medicare UPIN
CA00G231433Medicare PIN