Provider Demographics
NPI:1518121466
Name:MORRIS, LONNIE BRADLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:LONNIE
Middle Name:BRADLEY
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 1:340 NEW TOWNE RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-7966
Mailing Address - Country:US
Mailing Address - Phone:270-782-7768
Mailing Address - Fax:
Practice Address - Street 1:340 NEW TOWNE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-7966
Practice Address - Country:US
Practice Address - Phone:270-782-7768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45024207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100166510Medicaid
KY12369402OtherCAQH
KY7100166510Medicaid