MEDICARE: DR. GARY B MORRIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	3642592	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	778910	OTHER		MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001618089	OTHER		BLUE CROSS
3	0342700001	OTHER		ADMINISTAR

General Provider Information

NPI Number	:	1376528463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY B MORRIS MD

Provider Business Mailing Address
First Line	:	925 NORTH AVE
Second Line	:
City	:	DEERFIELD
State	:	IL
Zip	:	60015-2203
Country	:	US
Telephone Number	:	847-945-4188
Fax Number	:	847-945-8338

Provider Business Practice Location Address
First Line	:	4905 OLD ORCHARD CTR
Second Line	:	SUITE 430
City	:	SKOKIE
State	:	IL
Zip	:	60077-1458
Country	:	US
Telephone Number	:	847-674-8400
Fax Number	:	847-674-8465

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2005
Last Update Date	:	12/15/2011

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