Provider Demographics
NPI:1730180829
Name:MORRIS, ROBERT K (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:K
Last Name:MORRIS
Suffix:
Gender:M
Credentials:MD
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 773
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-0773
Mailing Address - Country:US
Mailing Address - Phone:419-897-9045
Mailing Address - Fax:866-205-0449
Practice Address - Street 1:5757 MONCLOVA RD
Practice Address - Street 2:SUITE 26
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1863
Practice Address - Country:US
Practice Address - Phone:419-897-9045
Practice Address - Fax:866-205-0449
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2013-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35055343208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0677450Medicaid
OH0677450Medicaid
OHMO0603534Medicare ID - Type Unspecified