Provider Demographics
NPI: | 1841299864 |
---|---|
Name: | MORRIS, HOWARD G (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | HOWARD |
Middle Name: | G |
Last Name: | MORRIS |
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: | 2801 RICHMOND ROAD |
Mailing Address - Street 2: | SUITE 362 |
Mailing Address - City: | TEXARKANA |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75503 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 903-293-4216 |
Mailing Address - Fax: | 903-614-5617 |
Practice Address - Street 1: | 2163 LIMA LOOP APT 07-021 |
Practice Address - Street 2: | |
Practice Address - City: | LAREDO |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78045 |
Practice Address - Country: | US |
Practice Address - Phone: | 903-293-4216 |
Practice Address - Fax: | 903-614-2131 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2005-07-20 |
Last Update Date: | 2021-06-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AR | N-7404 | 2085R0001X |
IN | 01077040Z | 2085R0001X |
TX | H4024 | 2085R0001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
SC | 752268615 | Other | TRICARE/CHAMPUS |
TN | D11H | Other | BLUE CROSS |
TX | 0325987-01 | Medicaid | |
AR | 50979 | Other | BLUE CROSS |
TX | 00D11H | Medicare PIN |