Provider Demographics
NPI:1861206641
Name:MORRISON, GORDON ROSS
Entity type:Individual
Prefix:MR
First Name:GORDON
Middle Name:ROSS
Last Name:MORRISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2137 S COMMERCE AVE UNIT 25
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-5765
Mailing Address - Country:US
Mailing Address - Phone:225-910-8811
Mailing Address - Fax:
Practice Address - Street 1:2137 S COMMERCE AVE UNIT 25
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-5765
Practice Address - Country:US
Practice Address - Phone:225-910-8811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver