Provider Demographics
NPI:1851342547
Name:JERRY W MORRIS PA
Entity Type:Organization
Organization Name:JERRY W MORRIS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-966-5154
Mailing Address - Street 1:PO BOX 96164
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-0126
Mailing Address - Country:US
Mailing Address - Phone:817-885-9242
Mailing Address - Fax:
Practice Address - Street 1:170 PLAYERS CIR
Practice Address - Street 2:SUITE 110
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6942
Practice Address - Country:US
Practice Address - Phone:817-885-9242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W748Medicare PIN