Provider Demographics
NPI:1003881590
Name:MORRIS, JERRY WALTER (DO)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:WALTER
Last Name:MORRIS
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:PO BOX 360541
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-6541
Mailing Address - Country:US
Mailing Address - Phone:972-525-9900
Mailing Address - Fax:469-333-7988
Practice Address - Street 1:8955 N TARRANT PKWY
Practice Address - Street 2:
Practice Address - City:N RICHLND HLS
Practice Address - State:TX
Practice Address - Zip Code:76182-8466
Practice Address - Country:US
Practice Address - Phone:972-525-9900
Practice Address - Fax:469-333-7988
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6536207Q00000X, 2083P0901X, 209800000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No209800000XAllopathic & Osteopathic PhysiciansLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E46850Medicare UPIN
TX8F3401Medicare PIN