Provider Demographics
NPI:1346387305
Name:MORRIS, LOWELL GARDNER (PA-C)
Entity type:Individual
Prefix:MR
First Name:LOWELL
Middle Name:GARDNER
Last Name:MORRIS
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:90 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CASTLE DALE
Mailing Address - State:UT
Mailing Address - Zip Code:84513-4527
Mailing Address - Country:US
Mailing Address - Phone:850-389-8333
Mailing Address - Fax:850-279-6031
Practice Address - Street 1:1001 W. COLLEGE BLVD
Practice Address - Street 2:BUILDING 1,SUITE D
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1049
Practice Address - Country:US
Practice Address - Phone:850-389-8333
Practice Address - Fax:850-279-6031
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2017-12-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA91909559363AM0700X
UT5368731-8002363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT463985Medicare Oscar/Certification