Provider Demographics
NPI:1790720779
Name:MORRIS, JASON KENDELL (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:KENDELL
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 1:618 FREDERICK DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2006
Mailing Address - Country:US
Mailing Address - Phone:662-299-2999
Mailing Address - Fax:662-846-8989
Practice Address - Street 1:618 FREDERICK DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2006
Practice Address - Country:US
Practice Address - Phone:662-299-2999
Practice Address - Fax:662-846-8989
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-03892085B0100X
MS141812085B0100X, 2085R0204X
LAMD.2001412085B0100X
GA0490692085B0100X
TN6934032085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118193Medicaid
AR156472001Medicaid
MS300126521OtherRAIL ROAD MEDICARE
AR5M809OtherBLUE CROSS/ BLUE SHIELD
MS00118193Medicaid
AR5M809OtherBLUE CROSS/ BLUE SHIELD
AR156472001Medicaid