Individual
DR. JOSEPH M. MORTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1512 12TH AVE RD, NAMPA, ID 83686-6008
(866) 263-1223
(208) 463-5081
Mailing address
104 W 5TH AVE, SUITE #250E, SPOKANE, WA 99204-4880
(866) 263-1223
(509) 835-4058
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
M-11657
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942461850
—
ID
Enumeration date
06/23/2008
Last updated
09/11/2012
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