Provider Demographics
NPI:1770573339
Name:MORRISON, TED L (PAC)
Entity type:Individual
Prefix:
First Name:TED
Middle Name:L
Last Name:MORRISON
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DAHLIA & 10TH
Mailing Address - Street 2:
Mailing Address - City:ANTONITO
Mailing Address - State:CO
Mailing Address - Zip Code:81120
Mailing Address - Country:US
Mailing Address - Phone:719-376-5426
Mailing Address - Fax:719-376-5880
Practice Address - Street 1:DAHLIA & 10TH
Practice Address - Street 2:
Practice Address - City:ANTONITO
Practice Address - State:CO
Practice Address - Zip Code:81120
Practice Address - Country:US
Practice Address - Phone:719-376-5426
Practice Address - Fax:719-376-5880
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO840706945083OtherROCKY MOUNTAIN HEALTH PLA
970027929OtherTRAVELERS MEDICARE
970027929OtherTRAVELERS MEDICARE
S35322Medicare UPIN