Mortenson, Blake C.

Mortenson, Blake C. is an individual health care provider with primary practice located at 1400 N 500 E , Logan UT 84341-2455. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Mortenson, Blake C. can be contacted via phone (435) 716-1000.

Contact Information

Primary practice address
1400 N 500 E Logan UT 84341-2455
Phone: (435) 716-1000
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 48375961205 Utah

Profile Details

NPI number 1427056860
LBN Legal business name Mortenson, Blake C.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 11th, 2005
Last updated Apr 20th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1427056860 NPPES
Wyoming MEDICAID 118743100
Wyoming MEDICAID D4474
Wyoming MEDICAID 806638500

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