Provider Demographics
NPI:1760591705
Name:MORRIS, DONALD G
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:G
Last Name:MORRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15838 FOUNTAIN PLAZA DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017
Mailing Address - Country:US
Mailing Address - Phone:636-484-5220
Mailing Address - Fax:636-484-5221
Practice Address - Street 1:15838 FOUNTAIN PLAZA DR
Practice Address - Street 2:SUITE A
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017
Practice Address - Country:US
Practice Address - Phone:636-484-5220
Practice Address - Fax:636-484-5221
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103615207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205273204Medicaid
MO205273204Medicaid
G50010Medicare UPIN