Provider Demographics
NPI:1578598702
Name:MORTON, PATRICK DAVID (DO)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:DAVID
Last Name:MORTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21150 BISCAYNE BLVD
Mailing Address - Street 2:#106
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1226
Mailing Address - Country:US
Mailing Address - Phone:305-932-9111
Mailing Address - Fax:305-932-2364
Practice Address - Street 1:21150 BISCAYNE BLVD
Practice Address - Street 2:#106
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1226
Practice Address - Country:US
Practice Address - Phone:305-932-9111
Practice Address - Fax:305-932-2364
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6950207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250477400Medicaid
FLG32256Medicare UPIN