Provider Demographics
NPI:1356334213
Name:MORRISON, MAURY KEESLER (MD)
Entity type:Individual
Prefix:
First Name:MAURY
Middle Name:KEESLER
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 1:3311 PRESCOTT RD STE 411
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3985
Mailing Address - Country:US
Mailing Address - Phone:318-448-5310
Mailing Address - Fax:318-448-7110
Practice Address - Street 1:3311 PRESCOTT RD STE 411
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3985
Practice Address - Country:US
Practice Address - Phone:318-448-5310
Practice Address - Fax:318-448-7110
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020642207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1658821Medicaid
LA1658821Medicaid
LA5W109Medicare ID - Type Unspecified