Individual
ALAN E MORTIMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1500 E 10TH ST, ATLANTIC, IA 50022-1935
(712) 243-5091
(712) 243-1337
Mailing address
1500 E 10TH ST, ATLANTIC, IA 50022-1935
(712) 243-5091
(712) 243-1337
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15113
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0177394
—
IA
01
—
68236
WELLMARK
IA
Enumeration date
12/23/2015
Last updated
12/23/2015
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