Provider Demographics
NPI:1740200385
Name:MORRIS, ROBERT ALAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALAN
Last Name:MORRIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 5TH AVE S APT 405
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-4607
Mailing Address - Country:US
Mailing Address - Phone:360-220-0236
Mailing Address - Fax:
Practice Address - Street 1:1110 5TH AVE S APT 405
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-4607
Practice Address - Country:US
Practice Address - Phone:360-220-0236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA 10001567363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2064MOOtherREGENCE BLUESHIELD
WA07781OtherFIRSTCHOICE
WA2064MOOtherREGENCE BLUESHIELD
WAGAB11355Medicare ID - Type Unspecified