Provider Demographics
NPI:1538138151
Name:MORRIS, JON B (PAC)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:B
Last Name:MORRIS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:44405 WOODWARD AVE
Mailing Address - Street 2:ATTN CARDIOTHORACIC SURGERY
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5023
Mailing Address - Country:US
Mailing Address - Phone:248-858-6717
Mailing Address - Fax:248-858-6274
Practice Address - Street 1:44405 WOODWARD AVE
Practice Address - Street 2:ATTN CARDIOTHORACIC SURGERY
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5023
Practice Address - Country:US
Practice Address - Phone:248-858-6717
Practice Address - Fax:248-858-6274
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601001916363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00198482OtherTRAVELERS