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General NPI Number Information
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NPI Number | 1245273499
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Entity Type | Individual
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Provider Name | MORTON D DUDLEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 10/05/2012
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Provider Practice Location Address
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Address Line | 1229 MADISON ST SUITE 900
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City | SEATTLE
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State | WA
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Zip | 98104-3586
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Country | US
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Telephone | 206-292-6233
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Fax | 206-292-7764
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Provider Business Mailing Address
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Address Line | 5225 82ND AVE SE
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City | MERCER ISLAND
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State | WA
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Zip | 98040-4613
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Country | US
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Telephone | 206-236-2621
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD00021531
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | MD00021531
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License Number State | WA
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