Provider Demographics
NPI:1861446197
Name:MORRIS, BILLY
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:
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 1:708 DEL PRADO BLVD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-5616
Mailing Address - Country:US
Mailing Address - Phone:239-574-5864
Mailing Address - Fax:239-574-1451
Practice Address - Street 1:708 DEL PRADO BLVD
Practice Address - Street 2:SUITE 9
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-5616
Practice Address - Country:US
Practice Address - Phone:239-574-5864
Practice Address - Fax:239-574-1451
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102941363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292105700Medicaid
FL290136OtherAMERIGROUP
FLQ35980Medicare UPIN
FLU4225AMedicare ID - Type Unspecified
FLP00390846Medicare PIN
FL292105700Medicaid