Healthcare Provider Details

I. General information

NPI: 1922018217
Provider Name (Legal Business Name): ANTHONY JOHN MORTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 VASSAR DR NE ALBUQUERQUE INDIAN HEALTH CENTER
ALBUQUERQUE NM
87106-2725
US

IV. Provider business mailing address

1001 MONTCLAIRE DR NE
ALBUQUERQUE NM
87110-6127
US

V. Phone/Fax

Practice location:
  • Phone: 505-248-4065
  • Fax: 505-248-4093
Mailing address:
  • Phone: 505-554-8581
  • Fax: 505-248-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD-11310
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: