Healthcare Provider Details

I. General information

NPI: 1750452686
Provider Name (Legal Business Name): RICHARD L ORTH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 NW 5TH AVE
ESTACADA OR
97023-7732
US

IV. Provider business mailing address

36488 SE LOG LEBARRE RD
ESTACADA OR
97023-7625
US

V. Phone/Fax

Practice location:
  • Phone: 503-852-5668
  • Fax: 971-399-8728
Mailing address:
  • Phone: 503-852-5668
  • Fax: 971-399-8728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO13484
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: