Basic Information
Provider Information
NPI: 1467615849
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MORTON
FirstName: DAVID
MiddleName: TROGDON
NamePrefix:  
NameSuffix:  
Credential: DPM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4815 N ASSEMBLY ST
Address2:  
City: SPOKANE
State: WA
PostalCode: 992056185
CountryCode: US
TelephoneNumber: 5094347006
FaxNumber:  
Practice Location
Address1: 4815 N ASSEMBLY ST
Address2:  
City: SPOKANE
State: WA
PostalCode: 992056185
CountryCode: US
TelephoneNumber: 5094347006
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/07/2008
LastUpdateDate: 03/02/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
213ES0131X00000352WAY Podiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery

No ID Information.


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