Healthcare Provider Details

I. General information

NPI: 1205875788
Provider Name (Legal Business Name): GREGORY J ORTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 LAKE ALVAMAR DR
LAWRENCE KS
66047-9303
US

IV. Provider business mailing address

1770 IOWA AVE STE 280
RIVERSIDE CA
92507-7401
US

V. Phone/Fax

Practice location:
  • Phone: 785-760-2937
  • Fax:
Mailing address:
  • Phone: 951-786-0801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC1-0025600
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberS6910
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number04-28207
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101288671
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0428207
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: