Provider Demographics
NPI:1306835400
Name:MORSE, JACK (MD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:MORSE
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:PO BOX 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-531-4262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBH1011207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139797823Medicaid
TX75-1976930-005OtherTRICARE
TX75-0818167-044OtherTRICARE
TX75-2616977-001OtherTRICARE
TX75-0818167-048OtherTRICARE
TX080146354OtherRAIL ROAD
TX75-2616977-002OtherTRICARE
TXP00792079OtherRAIL ROAD
TX139797822Medicaid
TX0061EGOtherBCBS
TX139797813Medicaid
TX139797825Medicaid
TX75-0818167-022OtherTRICARE
TXP01304469OtherRAIL ROAD
TX139797821Medicaid
TX139797824Medicaid
TX75-0818167-015OtherTRICARE
TX75-2616977-028OtherTRICARE
TX8DP962OtherBCBS
TX8DU468OtherBCBS
TX75-1976930-005OtherTRICARE
TX75-0818167-015OtherTRICARE
TX139797813Medicaid
TXP00792079OtherRAIL ROAD
TX269156YMAFMedicare PIN
TX080146354OtherRAIL ROAD
TX8DU468OtherBCBS