Provider Demographics
NPI:1487670618
Name:MORRISON, AUBREY R (MD)
Entity Type:Individual
Prefix:DR
First Name:AUBREY
Middle Name:R
Last Name:MORRISON
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 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8126
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-7603
Mailing Address - Fax:314-361-4197
Practice Address - Street 1:4921 PARKVIEW PL STE 5C
Practice Address - Street 2:STE 5C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-7603
Practice Address - Fax:314-361-4197
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO34792207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200963007Medicaid
IL5390360002Medicaid
MO117010183Medicare PIN
MO390003365Medicare PIN