Provider Demographics
NPI:1386683498
Name:MORRIS, MARK D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
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 1:11 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-9404
Mailing Address - Country:US
Mailing Address - Phone:828-658-1988
Mailing Address - Fax:
Practice Address - Street 1:11 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-9404
Practice Address - Country:US
Practice Address - Phone:828-658-1988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27263207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ27263Medicaid
NC60981OtherBCBS
NC8960981Medicaid
NC8960981Medicaid
C01615Medicare UPIN
P00010548Medicare ID - Type UnspecifiedRAILROAD MEDICARE