Healthcare Provider Details

I. General information

NPI: 1861991952
Provider Name (Legal Business Name): JIM MORRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 N CLINTON AVE
ROCHESTER NY
14604-1455
US

IV. Provider business mailing address

87 N CLINTON AVE
ROCHESTER NY
14604-1455
US

V. Phone/Fax

Practice location:
  • Phone: 585-546-7220
  • Fax:
Mailing address:
  • Phone: 585-546-7220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: