Provider Demographics
NPI:1922311190
Name:RANDY L. MORTON, M.D., PLLC
Entity Type:Organization
Organization Name:RANDY L. MORTON, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:LOREN
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-753-7205
Mailing Address - Street 1:3209 N 4TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5171
Mailing Address - Country:US
Mailing Address - Phone:903-753-7205
Mailing Address - Fax:903-238-8862
Practice Address - Street 1:3209 N 4TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5171
Practice Address - Country:US
Practice Address - Phone:903-753-7205
Practice Address - Fax:903-238-8862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5407208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty