Provider Demographics
NPI:1558477802
Name:MORRELL, DOUGLAS WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:WAYNE
Last Name:MORRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46173-1319
Mailing Address - Country:US
Mailing Address - Phone:765-932-2965
Mailing Address - Fax:765-932-4859
Practice Address - Street 1:606 E 11TH ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IN
Practice Address - Zip Code:46173-1319
Practice Address - Country:US
Practice Address - Phone:765-932-2965
Practice Address - Fax:765-932-4859
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01024901A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100215960AMedicaid
B29335Medicare UPIN
710400Medicare ID - Type Unspecified