Provider Demographics
NPI:1326018441
Name:ORTMAN, HOWARD SCOTT (DPM)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:SCOTT
Last Name:ORTMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 D ST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3707
Mailing Address - Country:US
Mailing Address - Phone:415-454-1944
Mailing Address - Fax:415-454-3515
Practice Address - Street 1:711 D ST
Practice Address - Street 2:SUITE 114
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3707
Practice Address - Country:US
Practice Address - Phone:415-454-1944
Practice Address - Fax:415-454-3515
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2162213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8874019Medicaid
CA8874019Medicaid
T11209Medicare UPIN