Provider Demographics
NPI:1750452686
Name:ORTH, RICHARD L (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:ORTH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:36488 SE LOG LEBARRE RD
Mailing Address - Street 2:
Mailing Address - City:ESTACADA
Mailing Address - State:OR
Mailing Address - Zip Code:97023-7625
Mailing Address - Country:US
Mailing Address - Phone:503-852-5668
Mailing Address - Fax:971-399-8728
Practice Address - Street 1:107 NW 5TH AVE
Practice Address - Street 2:
Practice Address - City:ESTACADA
Practice Address - State:OR
Practice Address - Zip Code:97023-7732
Practice Address - Country:US
Practice Address - Phone:503-852-5668
Practice Address - Fax:971-399-8728
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORDO13484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR283507Medicaid
OR283507Medicaid
ORR0000WCPCSMedicare PIN