MEDICARE: DAVID MICHAEL MOURNING M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	MD00043382	WA
2	207XS0117X	Orthopaedic Surgery of the Spine Physician	MD00043382	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00161526	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8918MO	OTHER		REGENCE BLUESHIELD
3	8939669	OTHER	WA	CRIME VICTIMS COMP

General Provider Information

NPI Number	:	1033150420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID MICHAEL MOURNING M.D.

Provider Business Mailing Address
First Line	:	1400 E KINCAID ST
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-4127
Country	:	US
Telephone Number	:	360-814-6451
Fax Number	:	360-445-8592

Provider Business Practice Location Address
First Line	:	2320 FREEWAY DR
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273-5445
Country	:	US
Telephone Number	:	360-814-6800
Fax Number	:	360-814-6953

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	03/07/2023

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Directions to “ DAVID MICHAEL MOURNING M.D.” Practice Location

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