Provider Demographics
NPI:1467414268
Name:MORRIS, SEQUITA M (MD)
Entity Type:Individual
Prefix:DR
First Name:SEQUITA
Middle Name:M
Last Name:MORRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 GRAVOIS BLUFFS BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-7758
Mailing Address - Country:US
Mailing Address - Phone:636-685-7734
Mailing Address - Fax:
Practice Address - Street 1:774 GRAVOIS BLUFFS BLVD
Practice Address - Street 2:STE B
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-7758
Practice Address - Country:US
Practice Address - Phone:636-685-7734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010039469207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA6138001Medicare PIN
TXI17926Medicare UPIN
TX167951601Medicaid