Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DE00004296 | WA |
NPI | 1700975919 |
---|---|
Provider Name | Thomas Morton JR. |
First Address | Seattle, WA 98195-0001 |
Second Address | Seattle, WA 98195-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 12/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
188482 | L AND I (01) | WA |
7074222 | (05) | WA |
T01738 | (02) | WA |