Provider Demographics
NPI:1740371921
Name:MORRIS, DARELD RAY II (DO)
Entity type:Individual
Prefix:
First Name:DARELD
Middle Name:RAY
Last Name:MORRIS
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6800 PORTO FINO CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-7133
Mailing Address - Country:US
Mailing Address - Phone:239-418-0775
Mailing Address - Fax:239-418-0630
Practice Address - Street 1:45 BRYAN AVE
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935-4647
Practice Address - Country:US
Practice Address - Phone:863-675-3427
Practice Address - Fax:863-675-3809
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2024-12-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS6547207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F48541Medicare UPIN
F48541Medicare UPIN