Provider Demographics
NPI:1528160355
Name:MORRISON, ELIZABETH DANA (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DANA
Last Name:MORRISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LESA
Other - Middle Name:DANA
Other - Last Name:MORRISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:500 W FORT ST # 111
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4599
Mailing Address - Country:US
Mailing Address - Phone:208-422-1325
Mailing Address - Fax:208-422-1319
Practice Address - Street 1:500 W FORT ST # 111
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4599
Practice Address - Country:US
Practice Address - Phone:208-422-1325
Practice Address - Fax:208-422-1319
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA35085207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA221430Medicare UPIN