BLAKE C MORTENSON, MD, Diagnostic Radiology LOGAN, UT

Contact Information

BLAKE C MORTENSON, MD

1400 N 500 E
LOGAN, UT 84341-2455

Phone: 435-716-1000
Fax:
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Diagnostic Radiology	2085R0202X	30	Physician/Diagnostic Radiology

Indicates primary specialty

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NPI Profile & details for BLAKE C MORTENSON · (Male)

NPI #	`1427056860`
Status	Active
Credentials	MD
Entity	Individual
Enumeration date	07/11/2005
Last updated	04/20/2015 - About 11 years ago
Sole proprietor ¹	No
Identifiers	UT License # 48375961205 ID Medicaid 806638500 UT Medicaid D4474 WY Medicaid 118743100
Hospital affiliation(s)	BEAR RIVER VALLEY HOSPITAL - (Acute Care) 905 NORTH 1000 WEST TREMONTON, UT 84337 LOGAN REGIONAL HOSPITAL - (Acute Care) 500 EAST 1400 NORTH LOGAN, UT 84341

¹ A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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BLAKE C MORTENSON, MD – NPI #1427056860Diagnostic Radiology

Contact Information

Specialty

Diagnostic Radiology

NPI Profile & details for BLAKE C MORTENSON · (Male)

Reviews for BLAKE C MORTENSON

BLAKE C MORTENSON, MD – NPI #1427056860
Diagnostic Radiology