Provider Demographics
NPI:1083721195
Name:MORRIS, LARA (PA)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 SOUTH CASCADE AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903
Mailing Address - Country:US
Mailing Address - Phone:719-522-1133
Mailing Address - Fax:719-264-1772
Practice Address - Street 1:2405 RESEARCH PARKWAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3420
Practice Address - Country:US
Practice Address - Phone:719-522-1133
Practice Address - Fax:719-264-1772
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO1547363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO95402268Medicaid
CO95402268Medicaid
COC804340Medicare PIN