Provider Demographics
NPI:1538438411
Name:RAY L MORRISON D.O. PA
Entity type:Organization
Organization Name:RAY L MORRISON D.O. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.O. OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DO PA
Authorized Official - Phone:936-544-7757
Mailing Address - Street 1:200 RENAISSANCE WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CROCKETT
Mailing Address - State:TX
Mailing Address - Zip Code:75835-1772
Mailing Address - Country:US
Mailing Address - Phone:936-544-7757
Mailing Address - Fax:936-545-0952
Practice Address - Street 1:200 RENAISSANCE WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:CROCKETT
Practice Address - State:TX
Practice Address - Zip Code:75835-1772
Practice Address - Country:US
Practice Address - Phone:936-544-7757
Practice Address - Fax:936-545-0952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDOH2621208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033511901Medicaid
TXTXB144838OtherMEDICARE ID
TXTXB144838OtherMEDICARE ID