Healthcare Provider Details

I. General information

NPI: 1518121466
Provider Name (Legal Business Name): LONNIE BRADLEY MORRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 NEW TOWNE RD
BOWLING GREEN KY
42103-7966
US

IV. Provider business mailing address

340 NEW TOWNE RD
BOWLING GREEN KY
42103-7966
US

V. Phone/Fax

Practice location:
  • Phone: 270-782-7768
  • Fax:
Mailing address:
  • Phone: 270-782-7768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number45024
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: