Healthcare Provider Details

I. General information

NPI: 1003194200
Provider Name (Legal Business Name): DONALD L MORTON MD & ASSOCIATES MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2011
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 22ND ST
SANTA MONICA CA
90404-2032
US

IV. Provider business mailing address

2200 SANTA MONICA BLVD
SANTA MONICA CA
90404-2302
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-8781
  • Fax:
Mailing address:
  • Phone: 310-829-8781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberA18794
License Number StateCA

VIII. Authorized Official

Name: DONALD L MORTON
Title or Position: PRESIDENT
Credential: MD
Phone: 310-829-8781