Provider Demographics
NPI:1497799605
Name:MORTON, JEFFERY DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:DOUGLAS
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:3720 SOUTH I 35 EAST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210
Practice Address - Country:US
Practice Address - Phone:940-382-1022
Practice Address - Fax:940-380-7904
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ26932085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139115304Medicaid
TX139115301Medicaid
TX139115305Medicaid
TX139115313Medicaid
TX139115309Medicaid
TX139115307OtherCSHCN
TX8R1507OtherBLUE CROSS OF TX
TX88245KMedicare PIN
TX139115301Medicaid
TXE79861Medicare UPIN
TX139115313Medicaid
TX920005927Medicare PIN