Provider Demographics
NPI:1568564664
Name:MORTON, KEITH A (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:A
Last Name:MORTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:509-747-2455
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:9911 N NEVADA ST STE 200
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1298
Practice Address - Country:US
Practice Address - Phone:509-626-9420
Practice Address - Fax:509-626-9421
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040869207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0162492OtherL&I
WA1568564664OtherNPI
WA1116680Medicaid
WA110242336OtherTRAV MEDICARE
WA110242336OtherTRAV MEDICARE
WA1116680Medicaid