Provider Demographics
NPI:1669424438
Name:MORRIS, VERNON RAYMOND JR (MD)
Entity type:Individual
Prefix:
First Name:VERNON
Middle Name:RAYMOND
Last Name:MORRIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VERNON
Other - Middle Name:RAYMOND
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3001 N ROCKY POINT DR E
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5810
Mailing Address - Country:US
Mailing Address - Phone:813-289-9613
Mailing Address - Fax:813-902-6324
Practice Address - Street 1:3001 N ROCKY POINT DR E
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5810
Practice Address - Country:US
Practice Address - Phone:813-289-9613
Practice Address - Fax:813-902-6324
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL020645026204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266836000Medicaid
FL62940OtherBLUE CROSS BLUE SHIELD
FLME85558OtherSTATE LIC
FLME85558OtherSTATE LIC
62940Medicare ID - Type Unspecified