Provider Demographics
NPI:1861683377
Name:DR PAUL MORTON PA
Entity Type:Organization
Organization Name:DR PAUL MORTON PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELMA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOCANEGRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-614-1098
Mailing Address - Street 1:7711 LOUIS PASTEUR STE 503
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3419
Mailing Address - Country:US
Mailing Address - Phone:210-614-1098
Mailing Address - Fax:210-616-0533
Practice Address - Street 1:7711 LOUIS PASTEUR STE 503
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3419
Practice Address - Country:US
Practice Address - Phone:210-614-1098
Practice Address - Fax:210-616-0533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00640WMedicare PIN