Provider Demographics
NPI:1710957543
Name:MORRIS, GREGORY A (PA-C)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:A
Last Name:MORRIS
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3205 N ACADEMY BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5101
Mailing Address - Country:US
Mailing Address - Phone:719-632-5700
Mailing Address - Fax:
Practice Address - Street 1:117 W RIO GRANDE ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-4013
Practice Address - Country:US
Practice Address - Phone:719-630-6440
Practice Address - Fax:719-577-4362
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO752363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO87109760Medicaid
CO87109760Medicaid
COP23761Medicare UPIN