Provider Demographics
NPI:1194800664
Name:MORRISON, GLENN SCOTT (PA-C)
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:SCOTT
Last Name:MORRISON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 DE LA VINA ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3877
Mailing Address - Country:US
Mailing Address - Phone:805-682-2267
Mailing Address - Fax:805-687-3527
Practice Address - Street 1:2323 DE LA VINA ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3877
Practice Address - Country:US
Practice Address - Phone:805-682-2267
Practice Address - Fax:805-687-3527
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13631363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA13631Medicaid
CAPA13631Medicaid