Basic Information
Provider Information
NPI: 1366854978
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MORRISON
FirstName: CHAD
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3016 W CHARLESTON BLVD STE 100
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891021973
CountryCode: US
TelephoneNumber: 0276715150
FaxNumber:  
Practice Location
Address1: 1707 W CHARLESTON BLVD STE 160
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891022354
CountryCode: US
TelephoneNumber: 7026715150
FaxNumber: 7023846493
Other Information
ProviderEnumerationDate: 06/02/2014
LastUpdateDate: 01/25/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/25/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X5151012921MIN Allopathic & Osteopathic PhysiciansSurgery 
208600000XDO2542NVY Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


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