MEDICARE: DR. MICHAEL DIRK ORY 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	207Q00000X	Family Medicine Physician	009985	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962410597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL DIRK ORY M.D.

Provider Business Mailing Address
First Line	:	511 GREEN ST
Second Line	:
City	:	THIBODAUX
State	:	LA
Zip	:	70301-3221
Country	:	US
Telephone Number	:	985-446-8258
Fax Number	:

Provider Business Practice Location Address
First Line	:	22080 LA HWY 20
Second Line	:
City	:	VACHERIE
State	:	LA
Zip	:	70090
Country	:	US
Telephone Number	:	225-265-3061
Fax Number	:	225-265-3062

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/08/2007

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