Provider Demographics
NPI:1902974900
Name:MORTON, PETER M
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:M
Last Name:MORTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8433 N BLACK CANYON HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-4873
Mailing Address - Country:US
Mailing Address - Phone:602-249-8707
Mailing Address - Fax:602-788-0388
Practice Address - Street 1:8433 N BLACK CANYON HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4873
Practice Address - Country:US
Practice Address - Phone:602-249-8707
Practice Address - Fax:602-788-0388
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1776103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPHD1776Medicare ID - Type Unspecified