Provider Demographics
NPI:1609824234
Name:MORRIS, MICHAEL D (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:MORRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DALE
Other - Middle Name:
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:159 LONGVIEW DR
Practice Address - Street 2:SUITE C
Practice Address - City:DESTREHAN
Practice Address - State:LA
Practice Address - Zip Code:70047-5075
Practice Address - Country:US
Practice Address - Phone:985-764-7664
Practice Address - Fax:985-764-7234
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.09454R207P00000X
LA09454R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1937126Medicaid
MS00119194Medicaid
LA376061YH3VMedicare PIN
MS00119194Medicaid
LA5R274Medicare PIN
LA376061YH3UMedicare PIN