Healthcare Provider Details

I. General information

NPI: 1043400898
Provider Name (Legal Business Name): IRA A. MORRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35767 POND FORK RD
WHARTON WV
25208-0089
US

IV. Provider business mailing address

37456 COAL RIVER RD
WHITESVILLE WV
25209-0217
US

V. Phone/Fax

Practice location:
  • Phone: 304-247-6202
  • Fax: 304-247-6203
Mailing address:
  • Phone: 304-854-1323
  • Fax: 304-854-1021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18377
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: