Provider Demographics
NPI:1346308368
Name:MORTON, RONALD GLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:GLEN
Last Name:MORTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:901 BAZZELL DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-4302
Mailing Address - Country:US
Mailing Address - Phone:903-212-4399
Mailing Address - Fax:903-238-8862
Practice Address - Street 1:901 PEGUES PL
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-4027
Practice Address - Country:US
Practice Address - Phone:903-212-4399
Practice Address - Fax:903-236-3108
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH0660207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D67452Medicare UPIN