Healthcare Provider Details

I. General information

NPI: 1669413886
Provider Name (Legal Business Name): WAYNE L MORTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 GIESLER DRIVE
OSCEOLA MO
64776-6297
US

IV. Provider business mailing address

PO BOX 570
OSCEOLA MO
64776-0570
US

V. Phone/Fax

Practice location:
  • Phone: 417-646-8123
  • Fax: 417-646-8911
Mailing address:
  • Phone: 417-646-8123
  • Fax: 417-646-8911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR6098
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberR6098
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: