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General NPI Number Information
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NPI Number | 1942461850
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Entity Type | Individual
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Provider Name | JOSEPH M. MORTENSEN MD
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Gender | Male
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 1512 12TH AVE RD
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City | NAMPA
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State | ID
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Zip | 83686-6008
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Country | US
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Telephone | 866-263-1223
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Fax | 208-463-5081
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Provider Business Mailing Address
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Address Line | 104 W 5TH AVE SUITE #250E
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City | SPOKANE
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State | WA
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Zip | 99204-4880
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Country | US
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Telephone | 866-263-1223
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Fax | 509-835-4058
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | M-11657
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License Number State | ID
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