Provider Demographics
NPI:1104815810
Name:MORRIS, NICHOLAS W (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:W
Last Name:MORRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 MOUNTAIN VIEW ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2232
Mailing Address - Country:US
Mailing Address - Phone:307-754-4559
Mailing Address - Fax:307-754-7733
Practice Address - Street 1:450 MOUNTAIN VIEW ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2212
Practice Address - Country:US
Practice Address - Phone:307-754-7257
Practice Address - Fax:307-754-7217
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4680A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0981084Medicaid
WY100808100Medicaid
WY020015286OtherRAILROAD MEDICARE
WY305416OtherBLUE CROSS BLUE SHIELD
WY020015286OtherRAILROAD MEDICARE
WY100808100Medicaid