1063491918 NPI number — MARC JENNINGS MORSE M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063491918 NPI number — MARC JENNINGS MORSE M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MORSE

Provider First Name:

MARC

Provider Middle Name:

JENNINGS

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1063491918

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/01/2019

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

5767 W CENTURY BLVD STE 400

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

LOS ANGELES

Provider Business Mailing Address State Name:

CA

Provider Business Mailing Address Postal Code:

90045-5631

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

2701 OCEAN PARK BLVD STE 130

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SANTA MONICA

Provider Business Practice Location Address State Name:

CA

Provider Business Practice Location Address Postal Code:

90405

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

310-450-1200

Provider Business Practice Location Address Fax Number:

310-450-8830

Provider Enumeration Date:

01/10/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  G162875 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1063491918 . This is a "NPI #" identifier . This identifiers is of the category "OTHER".
• Identifier: 4653326 . This is a "AETNA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
• Identifier: 84136530206 . This is a "PACIFICARE PPO" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
• Identifier: 942854057067 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
• Identifier: 01319425 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
• Identifier: 04020541 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
• Identifier: 1215981634 . This is a "GROUP NPI #" identifier . This identifiers is of the category "OTHER".
• Identifier: 276003 . This is a "CIGNA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
• Identifier: 84136530203 . This is a "PACIFICAE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
• Identifier: MO103038 . This is a "ANTHEM BCBS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
• Identifier: RO103008 . This is a "GROUP ANTHEM BCBS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 841365302018 . This is a "RKY MTN HMO" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".