Provider Demographics
NPI:1306822713
Name:MORRIS, DAVID GLEN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:GLEN
Last Name:MORRIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 18962
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4084
Mailing Address - Country:US
Mailing Address - Phone:800-566-5050
Mailing Address - Fax:254-537-6466
Practice Address - Street 1:305 LONDONDERRY DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7929
Practice Address - Country:US
Practice Address - Phone:254-537-6464
Practice Address - Fax:254-537-6466
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA02311363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD 000Medicare UPIN