Provider Demographics
NPI:1760456222
Name:MORTON, TIMOTHY D (PA-C)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:D
Last Name:MORTON
Suffix:
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 1:2420 S UNION AVE
Mailing Address - Street 2:STE. 200
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1322
Mailing Address - Country:US
Mailing Address - Phone:253-272-8148
Mailing Address - Fax:253-404-0506
Practice Address - Street 1:3209 S 23RD ST
Practice Address - Street 2:STE. 340
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1602
Practice Address - Country:US
Practice Address - Phone:253-272-8148
Practice Address - Fax:253-404-0506
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10001637363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPA10001637OtherWA LICENSE
WA8327140Medicaid
WA0001045700Medicare PIN
WAG8851595Medicare PIN
WA8851594Medicare PIN
WAAB24853Medicare PIN
WAG8851597Medicare PIN
WAAB24854Medicare PIN
WA8327140Medicaid
WA000188100Medicare PIN
WAG8851594Medicare PIN
WAG8880511Medicare PIN
WAPA10001637OtherWA LICENSE