Mortlock, Paul David
Mortlock, Paul David is an individual health care provider with primary practice located at 400 Ne Mother Joseph Pl , Vancouver WA 98664-3200. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Mortlock, Paul David can be contacted via phone (360) 892-9664.Contact Information
Primary practice address
400 Ne Mother Joseph Pl
Vancouver WA 98664-3200
Phone: (360) 892-9664
Fax: (360) 892-9667
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | PA10004695 | Washington |
Profile Details
| NPI number | 1376506733 |
|---|---|
| LBN Legal business name | Mortlock, Paul David |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 7th, 2006 |
| Last updated | Dec 17th, 2018 - about 6 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1376506733 | NPPES |
| Idaho | MEDICAID | 807410400 | |
| Idaho | MEDICAID | 8418188 |
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