Provider Demographics
NPI:1770567000
Name:MORTON, GREGORY KEITH III (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:KEITH
Last Name:MORTON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 SW SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-5252
Mailing Address - Country:US
Mailing Address - Phone:580-355-9101
Mailing Address - Fax:580-355-9097
Practice Address - Street 1:412 SW SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-5252
Practice Address - Country:US
Practice Address - Phone:580-355-9101
Practice Address - Fax:580-355-9097
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14117207Q00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100008360CMedicaid
OK100008360CMedicaid
OKOKAAA1384Medicare PIN