1346387305 NPI number — MR. LOWELL GARDNER MORRIS PA-C

Table of content: MR. LOWELL GARDNER MORRIS PA-C (NPI 1346387305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346387305 NPI number — MR. LOWELL GARDNER MORRIS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORRIS
Provider First Name:
LOWELL
Provider Middle Name:
GARDNER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346387305
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASTLE DALE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84513-4527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-389-8333
Provider Business Mailing Address Fax Number:
850-279-6031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 W. COLLEGE BLVD
Provider Second Line Business Practice Location Address:
BUILDING 1,SUITE D
Provider Business Practice Location Address City Name:
NICEVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32578-1049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-389-8333
Provider Business Practice Location Address Fax Number:
850-279-6031
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA91909559 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 5368731-8002 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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