Provider Demographics
NPI:1518077189
Name:MORRIS, NATHANIEL L (MD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:L
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 1:10 N LOCUST ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-1192
Mailing Address - Country:US
Mailing Address - Phone:513-523-2340
Mailing Address - Fax:513-523-5080
Practice Address - Street 1:8 MAIN STREET
Practice Address - Street 2:
Practice Address - City:COLLEGE CORNER
Practice Address - State:OH
Practice Address - Zip Code:45003
Practice Address - Country:US
Practice Address - Phone:513-273-9944
Practice Address - Fax:513-273-9966
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076127207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000193226OtherANTHEM BCBS
OH4046582Medicare PIN
H34493Medicare UPIN
IN200220AMedicare PIN