Provider Demographics
NPI:1700866217
Name:MORRIS, ROBERT P (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:P
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 1:45 N FULTON ST
Mailing Address - Street 2:PO BOX 346
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077
Mailing Address - Country:US
Mailing Address - Phone:607-753-0683
Mailing Address - Fax:607-753-6408
Practice Address - Street 1:45 N FULTON ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:NY
Practice Address - Zip Code:13077
Practice Address - Country:US
Practice Address - Phone:607-753-0683
Practice Address - Fax:607-753-6408
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2150041207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H01186Medicare UPIN
CC2619Medicare ID - Type Unspecified