Provider Demographics
NPI:1306889456
Name:DILLARD, MORRIS STEPHEN (DO)
Entity type:Individual
Prefix:DR
First Name:MORRIS
Middle Name:STEPHEN
Last Name:DILLARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SHERWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9265
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3473
Practice Address - Country:US
Practice Address - Phone:304-831-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1102207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000724012OtherBC/BS
WV00421261001Medicaid
WV1047000OtherDWC
WV000724012OtherBC/BS
WVP00402259Medicare PIN
WV00421261001Medicaid
WVDI4156144Medicare PIN
OH$$$$$$$$$-00OtherBWC