Provider Demographics
NPI:1144571373
Name:ORTH, O. GERALD (MD)
Entity Type:Individual
Prefix:DR
First Name:O.
Middle Name:GERALD
Last Name:ORTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 BEACHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-1409
Mailing Address - Country:US
Mailing Address - Phone:573-445-6174
Mailing Address - Fax:
Practice Address - Street 1:2404 BEACHVIEW DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-1409
Practice Address - Country:US
Practice Address - Phone:573-445-6174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO29062207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery