Basic Information
| Provider Information | |||||||||
| NPI: | 1972528289 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORRISON | ||||||||
| FirstName: | ROY | ||||||||
| MiddleName: | WAYNE | ||||||||
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| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 846098 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752846098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9033246450 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 800 E DAWSON ST | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757012036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035314262 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 03/16/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 4318 | OK | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | N0293 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 750818167022 | 01 | TX | TRICARE | OTHER | 8BL716 | 01 | TX | BCBS MFH LOCATION | OTHER | 75-2616977-001 | 01 | TX | TRICARE | OTHER | 75-2616977-002 | 01 | TX | TRICARE | OTHER | 197108701 | 05 | TX | MEDICAID | 75-0818167-048 | 01 | TX | TRICARE | OTHER | P01304468 | 01 | TX | RAIL ROAD | OTHER | TIN PLUS 005 | 01 | TX | TRICARE JV LOCATION | OTHER | TIN PLUS 015 | 01 | TX | TRICARE MFH LOCATION | OTHER | TIN PLUS 044 | 01 | TX | TRICARE WINNSBORO LOCATION | OTHER | 197108704 | 05 | TX | MEDICAID | 197108705 | 05 | TX | MEDICAID | P00654710 | 01 | TX | RAIL ROAD | OTHER | 197108703 | 05 | TX | MEDICAID | 75-2616977-028 | 01 | TX | TRICARE | OTHER | 8AM872 | 01 | TX | BCBS | OTHER | 8BP165 | 01 | TX | BCBS JV LOCATION | OTHER | 8DP962 | 01 | TX | BCBS | OTHER | 8DU734 | 01 | TX | BCBS | OTHER | P01304456 | 01 | TX | RAIL ROAD | OTHER |