Healthcare Provider Details

I. General information

NPI: 1124040852
Provider Name (Legal Business Name): GREGORY A. MORTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GREGORY A. MORTER M.D.

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2304 DELANEY RD
WILMINGTON NC
28403-6013
US

IV. Provider business mailing address

2304 DELANEY RD
WILMINGTON NC
28403-6013
US

V. Phone/Fax

Practice location:
  • Phone: 910-763-3349
  • Fax: 910-251-9428
Mailing address:
  • Phone: 910-763-3349
  • Fax: 910-251-9428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number36401
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: