Provider Demographics
NPI:1174625842
Name:MORRIS, JEFFREY SELMAN (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SELMAN
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 1:110 W STREETSBORO ST
Mailing Address - Street 2:SUITE # 12
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-2775
Mailing Address - Country:US
Mailing Address - Phone:330-655-9555
Mailing Address - Fax:330-656-1855
Practice Address - Street 1:110 W STREETSBORO ST
Practice Address - Street 2:SUITE # 12
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-2775
Practice Address - Country:US
Practice Address - Phone:330-655-9555
Practice Address - Fax:330-656-1855
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-059366207X00000X, 207XS0106X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0813196Medicaid
OHM00672452Medicare ID - Type Unspecified
OHE59474Medicare UPIN