Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 020645026 | FL |
NPI | 1669424438 |
---|---|
Provider Name | Vernon Raymond Morris JR. |
First Address | Tampa, FL 33607-5810 |
Second Address | Tampa, FL 33607-5810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 13/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
266836000 | (05) | FL |
62940 | BLUE CROSS BLUE SHIELD (01) | FL |
D40167 | (02) | FL |
ME85558 | STATE LIC (01) | FL |