Provider Demographics
NPI:1518019413
Name:ORTON, WILLIAM JACK SR (PA C)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JACK
Last Name:ORTON
Suffix:SR
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 CAMPEN RD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:NC
Mailing Address - Zip Code:28516
Mailing Address - Country:US
Mailing Address - Phone:252-728-3875
Mailing Address - Fax:252-728-3594
Practice Address - Street 1:97 CAMPEN RD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:NC
Practice Address - Zip Code:28516
Practice Address - Country:US
Practice Address - Phone:252-728-3875
Practice Address - Fax:252-728-3594
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102012363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S80060Medicare UPIN
NC275834AMedicare ID - Type Unspecified