Provider Demographics
NPI:1376554659
Name:MORTON, GARY DALE (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:DALE
Last Name:MORTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100A W DEAN KEETON ST
Mailing Address - Street 2:1 UNIVERSITY STATION -- A3500
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78712-0000
Mailing Address - Country:US
Mailing Address - Phone:512-471-3515
Mailing Address - Fax:512-232-7314
Practice Address - Street 1:100A W DEAN KEETON ST
Practice Address - Street 2:1 UNIVERSITY STATION -- A3500
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1002
Practice Address - Country:US
Practice Address - Phone:512-471-3515
Practice Address - Fax:512-232-7314
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH06592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L13KMedicare ID - Type Unspecified