Provider Demographics
NPI:1225127053
Name:KORTZ, ERIC O (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:O
Last Name:KORTZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3333 S BANNOCK ST
Mailing Address - Street 2:SUITE 350
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2432
Mailing Address - Country:US
Mailing Address - Phone:303-957-1310
Mailing Address - Fax:303-761-4252
Practice Address - Street 1:601 E HAMPDEN AVE
Practice Address - Street 2:SUITE 470
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3781
Practice Address - Country:US
Practice Address - Phone:303-789-1877
Practice Address - Fax:303-789-2628
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2017-03-24
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Provider Licenses
StateLicense IDTaxonomies
CO31920208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01319201Medicaid
CO349478Medicare PIN
COF32024Medicare UPIN