Provider Demographics
NPI:1881782654
Name:MORRISON, JIMMY J (MD)
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:J
Last Name:MORRISON
Suffix:
Gender:
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:PO BOX 3988
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-3988
Mailing Address - Country:US
Mailing Address - Phone:618-457-5200
Mailing Address - Fax:618-529-0586
Practice Address - Street 1:404 LINCOLN DR
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3789
Practice Address - Country:US
Practice Address - Phone:618-993-0056
Practice Address - Fax:618-993-0752
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4691207RG0100X
IN01094030A207RG0100X
ARR-4256207RG0100X
UT14187430-1235207RG0100X
IL036.131531207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185127101Medicaid
TX185127103Medicaid
TX8J0243Medicare PIN
E93912Medicare UPIN
TX8L7526Medicare PIN
TX8J0243Medicare PIN
TX8L7526Medicare PIN
TX185127103Medicaid
AR120118001Medicaid
AR52571Medicare ID - Type Unspecified
TX185127101Medicaid