Provider Demographics
NPI:1750781506
Name:MORROW, DEREK NATHANIEL (PA)
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:NATHANIEL
Last Name:MORROW
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Gender:
Credentials:PA
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Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-362-3577
Mailing Address - Fax:314-362-2107
Practice Address - Street 1:1044 N MASON RD
Practice Address - Street 2:DEPT NEUROLOGICAL SURGERY, STE 110
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6431
Practice Address - Country:US
Practice Address - Phone:314-362-3577
Practice Address - Fax:314-362-2107
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2016023387363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO220038510Medicaid