Healthcare Provider Details

I. General information

NPI: 1699795229
Provider Name (Legal Business Name): CHARLES E MORRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 10/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2703 COUNTY ROAD 6800
WEST PLAINS MO
65775-6316
US

IV. Provider business mailing address

2703 COUNTY ROAD 6800
WEST PLAINS MO
65775-6316
US

V. Phone/Fax

Practice location:
  • Phone: 417-256-1630
  • Fax:
Mailing address:
  • Phone: 417-256-1630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number016634
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: