Provider Demographics
NPI:1023171014
Name:MORRIS, RAY III (MD)
Entity type:Individual
Prefix:
First Name:RAY
Middle Name:
Last Name:MORRIS
Suffix:III
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 1:3465 SO 4155 W SUITE #2
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-2082
Mailing Address - Country:US
Mailing Address - Phone:801-963-7636
Mailing Address - Fax:801-963-8130
Practice Address - Street 1:3465 SO 4155 W SUITE #2
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-2082
Practice Address - Country:US
Practice Address - Phone:801-963-7636
Practice Address - Fax:801-963-8130
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT932651751205207Q00000X
TXH1705207Q00000X
NY168063207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F45915Medicare UPIN
UT000011999Medicare ID - Type Unspecified