MEDICARE: DR. KENNETH LEE ORTEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	D2704	TX

General Provider Information

NPI Number	:	1376706465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH LEE ORTEN M.D.

Provider Business Mailing Address
First Line	:	14301 LAKE ROAD WEST
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75709-7325
Country	:	US
Telephone Number	:	903-561-8860
Fax Number	:

Provider Business Practice Location Address
First Line	:	14301 LAKE ROAD WEST
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75709-7325
Country	:	US
Telephone Number	:	903-561-8860
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	07/08/2008

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