Provider Demographics
NPI:1376528463
Name:MORRIS, GARY B (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:B
Last Name:MORRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:925 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-2203
Mailing Address - Country:US
Mailing Address - Phone:847-945-4188
Mailing Address - Fax:847-945-8338
Practice Address - Street 1:4905 OLD ORCHARD CTR
Practice Address - Street 2:SUITE 430
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1458
Practice Address - Country:US
Practice Address - Phone:847-674-8400
Practice Address - Fax:847-674-8465
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL3642592207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0001618089OtherBLUE CROSS
778910OtherMEDICARE GROUP
0342700001OtherADMINISTAR
K41298Medicare PIN
0342700001OtherADMINISTAR