Provider Demographics
NPI:1629020458
Name:WILFORD V MORRIS JR DO PA
Entity Type:Organization
Organization Name:WILFORD V MORRIS JR DO PA
Other - Org Name:BRAZOS VALLEY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILFORD
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:979-885-7466
Mailing Address - Street 1:1411 HIGHWAY 90 W
Mailing Address - Street 2:
Mailing Address - City:SEALY
Mailing Address - State:TX
Mailing Address - Zip Code:77474-3854
Mailing Address - Country:US
Mailing Address - Phone:979-885-7466
Mailing Address - Fax:979-885-6922
Practice Address - Street 1:1411 HIGHWAY 90 W
Practice Address - Street 2:
Practice Address - City:SEALY
Practice Address - State:TX
Practice Address - Zip Code:77474-3854
Practice Address - Country:US
Practice Address - Phone:979-885-7466
Practice Address - Fax:979-885-6922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3382261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center