Provider Demographics
NPI:1710980768
Name:ORTMAN, JOHN PHILIP (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PHILIP
Last Name:ORTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:75 HOSPITAL DR
Mailing Address - Street 2:SUITE 350
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2857
Mailing Address - Country:US
Mailing Address - Phone:740-592-4491
Mailing Address - Fax:740-592-4844
Practice Address - Street 1:75 HOSPITAL DR
Practice Address - Street 2:SUITE 350
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2857
Practice Address - Country:US
Practice Address - Phone:740-592-4491
Practice Address - Fax:740-592-4844
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-040760207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0448342OtherMEDICARE PROVIDER NUMBER
OH0334212Medicaid
OR0448342OtherMEDICARE PROVIDER NUMBER
310917093OtherCOMMERCIAL
000000117514OtherBLUE CROSS BLUE SHIELD
0691461OtherUNITED MINE WORKERS
OR0448342Medicare ID - Type Unspecified