Provider Demographics
NPI:1043400898
Name:MORRIS, IRA A (MD)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:A
Last Name:MORRIS
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 1:37456 COAL RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WHITESVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25209-0217
Mailing Address - Country:US
Mailing Address - Phone:304-854-1323
Mailing Address - Fax:304-854-1021
Practice Address - Street 1:35767 POND FORK RD
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:WV
Practice Address - Zip Code:25208-0089
Practice Address - Country:US
Practice Address - Phone:304-247-6202
Practice Address - Fax:304-247-6203
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV18377OtherSTATE LICENSE NUMBER
WV0046826000Medicaid
C49269Medicare UPIN
WV511823Medicare Oscar/Certification