Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Paul David Mortlock, PA-C

Individual provider Physician Assistant · NPI 1376506733

Paul David Mortlock, PA-C is a Physician Assistant in Vancouver, Washington. Qualified in 2004, 22 years ago. Practices with Radia Inc P S, a 274-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Washington.

Years since qualifying
22
Licensed in
WA
In the registry since
2006
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

400 NE Mother Joseph Pl
Vancouver, WA 98664-3200
Phone: (360) 892-9664
Fax: (360) 892-9667
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2101 Ne 139th St Ste 380, Vancouver, WA 98686-2309 — (360) 487-1888

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence PA10004695 (WA)
Physician Assistant Taxonomy 363A00000X · Licence PA10004695 (WA)

Record details

NPI number1376506733
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedApril 7, 2006
Last updated in NPPESAugust 29, 2024
Certification dateAugust 29, 2024
Mailing address19020 33rd Ave W Ste 210, Lynnwood, WA 98036-4748

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2004 (22 years in practice)
Group practice Radia Inc P S — 274 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations7 on file with Medicare

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