Basic Information
Provider Information
NPI: 1871586552
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MORRISON
FirstName: JOHN
MiddleName: DANIEL
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3333 BURNET AVE
Address2: MLC 7009
City: CINCINNATI
State: OH
PostalCode: 452293026
CountryCode: US
TelephoneNumber: 5136364225
FaxNumber: 5136362511
Practice Location
Address1: 3333 BURNET AVE
Address2: MLC 7009
City: CINCINNATI
State: OH
PostalCode: 452293026
CountryCode: US
TelephoneNumber: 5136364225
FaxNumber: 5136362511
Other Information
ProviderEnumerationDate: 08/26/2005
LastUpdateDate: 03/19/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174400000X29129KYN Other Service ProvidersSpecialist 
208000000X29129KYN Allopathic & Osteopathic PhysiciansPediatrics 
208000000X35.064977OHY Allopathic & Osteopathic PhysiciansPediatrics 

ID Information
IDTypeStateIssuerDescription
014713905OH MEDICAID
6429129705KY MEDICAID


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