Healthcare Provider Details

I. General information

NPI: 1770567000
Provider Name (Legal Business Name): GREGORY KEITH MORTON III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 SW SUMMIT AVE
LAWTON OK
73501-5252
US

IV. Provider business mailing address

412 SW SUMMIT AVE
LAWTON OK
73501-5252
US

V. Phone/Fax

Practice location:
  • Phone: 580-355-9101
  • Fax: 580-355-9097
Mailing address:
  • Phone: 580-355-9101
  • Fax: 580-355-9097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14117
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number14117
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: