Healthcare Provider Details

I. General information

NPI: 1700583911
Provider Name (Legal Business Name): CODY ORTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PASTEUR DR
PALO ALTO CA
94304-1048
US

IV. Provider business mailing address

2047 E REDONDO PL
SALT LAKE CITY UT
84108-3123
US

V. Phone/Fax

Practice location:
  • Phone: 650-723-4000
  • Fax:
Mailing address:
  • Phone: 307-248-8569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: