Basic Information
| Provider Information | |||||||||
| NPI: | 1083721195 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORRIS | ||||||||
| FirstName: | LARA | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 SOUTH CASCADE AVE | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195221133 | ||||||||
| FaxNumber: | 7192641772 | ||||||||
| Practice Location | |||||||||
| Address1: | 2405 RESEARCH PARKWAY | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809203420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195221133 | ||||||||
| FaxNumber: | 7192641772 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 09/18/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 1547 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 95402268 | 05 | CO | MEDICAID |