MEDICARE: DR. RICHARD J ORT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	38188	CO
2	207N00000X	Dermatology Physician	38188	CO
3	207ND0101X	MOHS-Micrographic Surgery Physician	38188	CO
4	207NP0225X	Pediatric Dermatology Physician	38188	CO
5	207NS0135X	Procedural Dermatology Physician	38188	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	06D0983760	OTHER	CO	CLIA NUMBER

General Provider Information

NPI Number	:	1093776593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD J ORT M.D.

Provider Business Mailing Address
First Line	:	9695 S YOSEMITE ST
Second Line	:	STE 175
City	:	LONE TREE
State	:	CO
Zip	:	80124-2888
Country	:	US
Telephone Number	:	720-344-5252
Fax Number	:

Provider Business Practice Location Address
First Line	:	9695 S YOSEMITE ST
Second Line	:	STE 175
City	:	LONE TREE
State	:	CO
Zip	:	80124-2888
Country	:	US
Telephone Number	:	720-344-5252
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2006
Last Update Date	:	08/01/2014

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