Individual
NATHAN THOMAS MORTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
505 PARNASSUS AVE FL 3, SAN FRANCISCO, CA 94143-2204
(415) 476-1537
(415) 476-0616
Mailing address
550 UNIVERSITY BLVD # 641, INDIANAPOLIS, IN 46202-5149
(317) 944-1816
(317) 948-2803
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
24382
CA
2085R0202X
Diagnostic Radiology Physician
A87377
CA
2085R0202X
Diagnostic Radiology Physician
DO187083
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500745314
—
OR
01
—
R202268
MEDICARE
—
Enumeration date
10/03/2012
Last updated
10/06/2025
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