Provider Demographics
NPI:1770967408
Name:MORRIS, KENNETH A (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:A
Last Name:MORRIS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9075
Mailing Address - Country:US
Mailing Address - Phone:970-667-7664
Mailing Address - Fax:970-622-9843
Practice Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 200
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9075
Practice Address - Country:US
Practice Address - Phone:970-667-7664
Practice Address - Fax:970-622-9843
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.067875207R00000X
MN611472084N0400X
WY12949A2084N0400X
CODR.00642262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000182442Medicaid