Provider Demographics
NPI:1659442028
Name:DEMORLIS, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:DEMORLIS
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:PO BOX 678
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MO
Mailing Address - Zip Code:65560-0678
Mailing Address - Country:US
Mailing Address - Phone:573-729-4310
Mailing Address - Fax:573-729-6526
Practice Address - Street 1:HIGHWAY 72 N
Practice Address - Street 2:BLDG # 1
Practice Address - City:SALEM
Practice Address - State:MO
Practice Address - Zip Code:65560-0678
Practice Address - Country:US
Practice Address - Phone:573-729-3410
Practice Address - Fax:573-729-6526
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2C15207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine