Healthcare Provider Details

I. General information

NPI: 1578847422
Provider Name (Legal Business Name): DEWAYNE R MORRIS ATP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 N LAMAR BLVD SUITE 206B
AUSTIN TX
78751-1837
US

IV. Provider business mailing address

5400 N LAMAR BLVD SUITE 206B
AUSTIN TX
78751-1837
US

V. Phone/Fax

Practice location:
  • Phone: 512-563-5104
  • Fax: 512-454-9521
Mailing address:
  • Phone: 512-563-5104
  • Fax: 512-454-9521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: