Provider Demographics
NPI:1548371537
Name:MORR, DOUGLAS JAY (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:JAY
Last Name:MORR
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 1:375 N WALL ST STE P310
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3484
Mailing Address - Country:US
Mailing Address - Phone:815-933-0194
Mailing Address - Fax:815-936-3847
Practice Address - Street 1:375 N WALL ST STE P310
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3484
Practice Address - Country:US
Practice Address - Phone:815-933-0194
Practice Address - Fax:815-936-3847
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068556207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036068556Medicaid
IL036068556Medicaid