Provider Demographics
NPI:1154390516
Name:MORRIS, ROBERT TIM (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:TIM
Last Name:MORRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1190 N STATE ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2413
Mailing Address - Country:US
Mailing Address - Phone:601-968-1377
Mailing Address - Fax:601-292-4595
Practice Address - Street 1:1190 N STATE ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2413
Practice Address - Country:US
Practice Address - Phone:601-968-1377
Practice Address - Fax:601-292-4595
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS11755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS168390705OtherUS DEPT OF LABOR
MS753068151004OtherTRICARE