Healthcare Provider Details

I. General information

NPI: 1588648356
Provider Name (Legal Business Name): JOHN R. MORTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 05/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 ARMISTICE BLVD
PAWTUCKET RI
02860-3210
US

IV. Provider business mailing address

111 BREWSTER ST DEPARTMENT OF OB/GYN
PAWTUCKET RI
02860-4400
US

V. Phone/Fax

Practice location:
  • Phone: 401-729-3600
  • Fax: 401-729-2580
Mailing address:
  • Phone: 401-729-3600
  • Fax: 401-729-2580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD11288
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: