Provider Demographics
NPI:1013453349
Name:JERRY L. MORRIS, M.D., INC.
Entity Type:Organization
Organization Name:JERRY L. MORRIS, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-834-1303
Mailing Address - Street 1:PO BOX 3969
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92781-3969
Mailing Address - Country:US
Mailing Address - Phone:714-542-8999
Mailing Address - Fax:714-834-1022
Practice Address - Street 1:1431 WARNER AVE STE A
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6444
Practice Address - Country:US
Practice Address - Phone:714-834-1303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21078103T00000X
171100000X, 207LP2900X, 207X00000X, 2086S0105X
CAC30959174400000X, 174400000X
CAA87133174400000X
CAE4065213ES0103X
CAPT27729261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC30959OtherBOARD OF ORTHOPEDIC SURGEON
CAC30959OtherSTATE LICENSE