Provider Demographics
NPI:1154769685
Name:MORRISON, JEREMY (DO)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:
Last Name:MORRISON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 ELLIOT ST
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-3208
Mailing Address - Country:US
Mailing Address - Phone:802-490-1904
Mailing Address - Fax:802-738-0087
Practice Address - Street 1:62 ELLIOT ST
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-3208
Practice Address - Country:US
Practice Address - Phone:802-490-1904
Practice Address - Fax:802-738-0087
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA256686207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1027050Medicaid