Healthcare Provider Details

I. General information

NPI: 1609824234
Provider Name (Legal Business Name): MICHAEL D MORRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DALE MORRIS M.D.

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 LONGVIEW DR SUITE C
DESTREHAN LA
70047-5075
US

IV. Provider business mailing address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121-2429
US

V. Phone/Fax

Practice location:
  • Phone: 985-764-7664
  • Fax: 985-764-7234
Mailing address:
  • Phone: 504-842-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.09454R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number09454R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: