Basic Information
| Provider Information | |||||||||
| NPI: | 1245273499 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUDLEY | ||||||||
| FirstName: | MORTON | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5225 82ND AVE SE | ||||||||
| Address2: | |||||||||
| City: | MERCER ISLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980404613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062362621 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1229 MADISON ST | ||||||||
| Address2: | SUITE 900 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981043586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062926233 | ||||||||
| FaxNumber: | 2062927764 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 10/05/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD00021531 | WA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | MD00021531 | WA | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1004589 | 05 | WA | MEDICAID |