MEDICARE: DERMATOLOGY AND LASER INSTITUTE OF COLORADO

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	207N00000X	Dermatology Physician	38188	CO

General Provider Information

NPI Number	:	1659321826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMATOLOGY AND LASER INSTITUTE OF COLORADO

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	:	720-344-0296

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	:	720-344-0296

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICHARD J ORT
Credential	:	M.D.
Telephone Number	:	720-344-5252

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	08/01/2014

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