Healthcare Provider Details

I. General information

NPI: 1003234535
Provider Name (Legal Business Name): HEATHER NICOLE ORTH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 07/21/2022
Certification Date: 03/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 E 19TH AVE
DENVER CO
80218-1114
US

IV. Provider business mailing address

10350 E DAKOTA AVE
DENVER CO
80247-1314
US

V. Phone/Fax

Practice location:
  • Phone: 303-338-4545
  • Fax:
Mailing address:
  • Phone: 303-338-3382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRS2014-0377
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDR.00058779
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: