Provider Demographics
NPI:1497861496
Name:MORTON, RANDY LOREN (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:LOREN
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 1:3209 N 4TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5145
Mailing Address - Country:US
Mailing Address - Phone:903-753-7205
Mailing Address - Fax:903-238-8862
Practice Address - Street 1:3209 N 4TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5145
Practice Address - Country:US
Practice Address - Phone:903-753-7205
Practice Address - Fax:903-238-8862
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5407208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B7751Medicare ID - Type Unspecified