Provider Demographics
NPI:1326058678
Name:MORRIS, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
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 1:2424 STEWARTSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1414
Mailing Address - Country:US
Mailing Address - Phone:304-276-3170
Mailing Address - Fax:
Practice Address - Street 1:2424 STEWARTSTOWN RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1414
Practice Address - Country:US
Practice Address - Phone:304-276-3170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22322207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1326058678OtherHEALTNET TRICARE
WV3810006057Medicaid
WV1883485OtherHIGHMARK WV
WVDA0096OtherRAILROAD GROUP PTAN
WVP01107340OtherRAILROAD MEDICARE
WVWV 1726AMedicare PIN