Provider Demographics
NPI:1235171182
Name:KORT, DANIEL DUANE (MD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:DUANE
Last Name:KORT
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:P.O. BOX 827
Mailing Address - Street 2:
Mailing Address - City:NEOTSU
Mailing Address - State:OR
Mailing Address - Zip Code:97364
Mailing Address - Country:US
Mailing Address - Phone:541-264-8332
Mailing Address - Fax:541-264-8376
Practice Address - Street 1:130 NW 19TH ST.
Practice Address - Street 2:SUITE A
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97364
Practice Address - Country:US
Practice Address - Phone:541-264-8332
Practice Address - Fax:541-264-8376
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18043207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500654301Medicaid
ORR176729Medicare UPIN
OR500654301Medicaid