Provider Demographics
NPI:1255179511
Name:MORTON, DANIEL JESUS (PA-C)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JESUS
Last Name:MORTON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-4919
Mailing Address - Country:US
Mailing Address - Phone:704-463-3060
Mailing Address - Fax:
Practice Address - Street 1:835 ALBEMARLE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NC
Practice Address - Zip Code:27371-8682
Practice Address - Country:US
Practice Address - Phone:704-463-3060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-19
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical