Healthcare Provider Details

I. General information

NPI: 1528039856
Provider Name (Legal Business Name): JOEL A. MORTON D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7219 N LITCHFIELD RD
LUKE AFB AZ
85309-1529
US

IV. Provider business mailing address

7219 N LITCHFIELD RD
LUKE AFB AZ
85309-1529
US

V. Phone/Fax

Practice location:
  • Phone: 623-856-9321
  • Fax: 623-856-2777
Mailing address:
  • Phone: 623-856-9321
  • Fax: 623-856-2777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number3490
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberAZ3490
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: