Provider Demographics
NPI:1588612501
Name:MORRIS, LAURA (MD)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 BRYANT IRVIN COURT
Mailing Address - Street 2:# 104
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-7680
Mailing Address - Country:US
Mailing Address - Phone:817-989-0300
Mailing Address - Fax:817-377-0970
Practice Address - Street 1:4840 BRYANT IRVIN COURT
Practice Address - Street 2:# 104
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-7680
Practice Address - Country:US
Practice Address - Phone:817-989-0300
Practice Address - Fax:817-377-0970
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7639207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN75UMedicare ID - Type UnspecifiedMEDICARE NUMBER
TXF67743Medicare UPIN