MEDICARE: DR. CHARLES JAY MORRIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G5401	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G5401	OTHER	TX	TEXAS LICENSE NUMBER

General Provider Information

NPI Number	:	1275541484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES JAY MORRIS M.D.

Provider Business Mailing Address
First Line	:	2258 BANCROFT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-3706
Country	:	US
Telephone Number	:	832-767-3409
Fax Number	:	713-961-4431

Provider Business Practice Location Address
First Line	:	1333 WEST LOOP S
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-9116
Country	:	US
Telephone Number	:	713-296-4849
Fax Number	:	713-961-4431

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	03/07/2023

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