Provider Demographics
NPI:1467466508
Name:MORRIS, RICHARD DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DAVID
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 1:1360 MASON AVE STE C
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5530
Mailing Address - Country:US
Mailing Address - Phone:386-255-6241
Mailing Address - Fax:
Practice Address - Street 1:1360 MASON AVE STE C
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5530
Practice Address - Country:US
Practice Address - Phone:386-255-6241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42683174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL64500OtherBCBS
FL4055412OtherAETNA
FL003867OtherFLORIDA HEALTHCARE
FL593539389OtherTAX ID NUMBER
FL64500OtherBCBS
FL003867OtherFLORIDA HEALTHCARE
FLD65453Medicare UPIN