Provider Demographics
NPI:1982732228
Name:MORRIS, ROBERT WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
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 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-2538
Mailing Address - Fax:
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-2538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL255082085R0202X
MS201452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009941700Medicaid
AL009941701Medicaid
AL051539848OtherBLUE CROSS
AL051539849OtherBLUE CROSS
AL051539851OtherBLUE CROS
AL191654Medicaid
MS02437052Medicaid
AL009941699Medicaid
MSP01640444OtherRAILROAD MEDICARE
AL009941697Medicaid
AL009941698Medicaid
AL009941702Medicaid
MS03604868Medicaid
AL051539846OtherBLUE CROSS
AL051539847OtherBLUE CROSS
AL051539850OtherBLUE CROSS
AL009941698Medicaid
MS472137YKDBMedicare PIN
AL051559022Medicare PIN
AL191654Medicaid