# DALE B MORTIMER MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023200813
- **Authorized official:** DALE BURTON MORTIMER MD (CHAIRMAN AND PRESIDENT)
- **Authorized official phone:** (360) 882-9058

## Contact information

- **Practice address:** 10000 NE 7TH AVE, SUITE 385, VANCOUVER, WA 98685-2955
- **Practice address phone:** (360) 882-9058
- **Practice address fax:** (360) 567-0861
- **Mailing address:** 800 NE TENNEY ROAD, PMB 110 232, VANCOUVER, WA 98685-2831
- **Mailing address phone:** (360) 882-9058
- **Mailing address fax:** (360) 567-0861

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0804X | Child & Adolescent Psychiatry Physician | MD00028371 | WA | Yes |

## Other

- **Enumeration date:** 08/15/2007
- **Last updated:** 08/15/2007