Healthcare Provider Details

I. General information

NPI: 1316937634
Provider Name (Legal Business Name): PATRICK R MORRIS D.D.S., M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11710 OLD BALLAS RD STE 208
SAINT LOUIS MO
63141-7076
US

IV. Provider business mailing address

11710 OLD BALLAS RD STE 208
SAINT LOUIS MO
63141-7076
US

V. Phone/Fax

Practice location:
  • Phone: 314-866-6725
  • Fax: 314-998-6725
Mailing address:
  • Phone: 314-866-6725
  • Fax: 314-998-6725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2000163887
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number015607
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: