Provider Demographics
NPI:1730280892
Name:BELLIS, MORRIS E (MD)
Entity Type:Individual
Prefix:
First Name:MORRIS
Middle Name:E
Last Name:BELLIS
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 1:1800 21ST AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-5759
Mailing Address - Country:US
Mailing Address - Phone:701-365-8700
Mailing Address - Fax:701-365-8701
Practice Address - Street 1:1800 21ST AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-5759
Practice Address - Country:US
Practice Address - Phone:701-365-8700
Practice Address - Fax:701-365-8701
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13924207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKB09444Medicare UPIN