Individual
PAUL DAVID MORTLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
400 NE MOTHER JOSEPH PL, VANCOUVER, WA 98664-3200
(360) 892-9664
(360) 892-9667
Mailing address
19020 33RD AVE W STE 210, LYNNWOOD, WA 98036-4748
(425) 563-1500
(425) 563-1374
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA10004695
WA
363AM0700X
Medical Physician Assistant
Primary
PA10004695
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807410400
—
ID
05
—
8418188
—
WA
Enumeration date
04/07/2006
Last updated
08/29/2024
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