Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DS 2596 | TN |
NPI | 1124133616 |
---|---|
Provider Name | Dr. Dwight Adair Morris |
First Address | Memphis, TN 38120-9426 |
Second Address | Memphis, TN 38120-9426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2008630 | BLUE CROSS BLUE SHIELD (01) | TN |
T74060 | (02) | TN |