Basic Information
Provider Information
NPI: 1578770475
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MORRIS
FirstName: ROBERT
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5080 SPECTRUM DR
Address2: SUITE 1200 WEST
City: ADDISON
State: TX
PostalCode: 750014648
CountryCode: US
TelephoneNumber: 9723648084
FaxNumber:  
Practice Location
Address1: 33089 GROESBECK HWY
Address2:  
City: FRASER
State: MI
PostalCode: 480261501
CountryCode: US
TelephoneNumber: 5862962800
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/17/2007
LastUpdateDate: 06/24/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2083X0100X4301055557MIY Allopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine

No ID Information.


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