Healthcare Provider Details

I. General information

NPI: 1245273499
Provider Name (Legal Business Name): MORTON D DUDLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 MADISON ST SUITE 900
SEATTLE WA
98104-3586
US

IV. Provider business mailing address

5225 82ND AVE SE
MERCER ISLAND WA
98040-4613
US

V. Phone/Fax

Practice location:
  • Phone: 206-292-6233
  • Fax: 206-292-7764
Mailing address:
  • Phone: 206-236-2621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD00021531
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD00021531
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: