Provider Demographics
NPI:1972528289
Name:MORRISON, ROY WAYNE (DO)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:WAYNE
Last Name:MORRISON
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:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6450
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-531-4262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4318207P00000X
TXN0293207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX750818167022OtherTRICARE
TX8BL716OtherBCBS MFH LOCATION
TX75-2616977-001OtherTRICARE
TX75-2616977-002OtherTRICARE
TX197108701Medicaid
TX75-0818167-048OtherTRICARE
TXP01304468OtherRAIL ROAD
TXTIN PLUS 005OtherTRICARE JV LOCATION
TXTIN PLUS 015OtherTRICARE MFH LOCATION
TXTIN PLUS 044OtherTRICARE WINNSBORO LOCATION
TX197108704Medicaid
TX197108705Medicaid
TXP00654710OtherRAIL ROAD
TX197108703Medicaid
TX75-2616977-028OtherTRICARE
TX8AM872OtherBCBS
TX8BP165OtherBCBS JV LOCATION
TX8DP962OtherBCBS
TX8DU734OtherBCBS
TXP01304456OtherRAIL ROAD
TX8AM872OtherBCBS
TX197108701Medicaid
TX75-2616977-001OtherTRICARE
TX75-2616977-028OtherTRICARE
TXP01304456OtherRAIL ROAD
TXTXB154366Medicare PIN