Provider Demographics
NPI:1952315665
Name:MORTON, REBECCA THERESE (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:THERESE
Last Name:MORTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:THERESE
Other - Last Name:MORTON NONWEILER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2865 DAGGETT AVE
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601
Mailing Address - Country:US
Mailing Address - Phone:541-882-6311
Mailing Address - Fax:503-225-9002
Practice Address - Street 1:2865 DAGGETT AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601
Practice Address - Country:US
Practice Address - Phone:541-882-6311
Practice Address - Fax:503-225-9002
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19774207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8187825Medicaid
OR050053965OtherRR MEDICARE
OR207506Medicaid
OR050053965OtherRR MEDICARE
G13239Medicare UPIN
WA8187825Medicaid
OR140782Medicare PIN