Provider Demographics
NPI:1033178843
Name:MCMORRIES, KIM ELLIOT (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:ELLIOT
Last Name:MCMORRIES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4710 NE STALLINGS DR
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1615
Mailing Address - Country:US
Mailing Address - Phone:936-560-2666
Mailing Address - Fax:936-560-2681
Practice Address - Street 1:4710 NE STALLINGS DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1615
Practice Address - Country:US
Practice Address - Phone:936-560-2666
Practice Address - Fax:936-560-2681
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8710207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035312001Medicaid
TX74-2164836OtherTIN
TX74-2164836OtherTIN
TX035312001Medicaid