Provider Demographics
NPI:1932119252
Name:MORRISON, STEPHEN K (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:K
Last Name:MORRISON
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 1:1101 JACKSON STREET SW
Mailing Address - Street 2:
Mailing Address - City:GRAVETTE
Mailing Address - State:AR
Mailing Address - Zip Code:72736-9121
Mailing Address - Country:US
Mailing Address - Phone:479-787-5291
Mailing Address - Fax:479-787-7890
Practice Address - Street 1:1101 JACKSON ST SW
Practice Address - Street 2:
Practice Address - City:GRAVETTE
Practice Address - State:AR
Practice Address - Zip Code:72736-9121
Practice Address - Country:US
Practice Address - Phone:479-787-5291
Practice Address - Fax:479-787-7890
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK31816208600000X
ARN5769208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR110835001Medicaid
AR110835001Medicaid
ARD84293Medicare UPIN