Healthcare Provider Details

I. General information

NPI: 1093776593
Provider Name (Legal Business Name): RICHARD J ORT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2006
Last Update Date: 08/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9695 S YOSEMITE ST STE 175
LONE TREE CO
80124-2888
US

IV. Provider business mailing address

9695 S YOSEMITE ST STE 175
LONE TREE CO
80124-2888
US

V. Phone/Fax

Practice location:
  • Phone: 720-344-5252
  • Fax:
Mailing address:
  • Phone: 720-344-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number38188
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number38188
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number38188
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number38188
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number38188
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: