Donald W Fortlage, is a
Pediatrics physician based in Milwaukie, Oregon. Donald W Fortlage is licensed to practice in Oregon (license number MD07219) and his current practice location is 10202 Se 32nd Ave, Suite 201, Milwaukie, Oregon. He can be reached at his office (for appointments etc.) via phone at
(503) 653-0770.
NPI number for Donald W Fortlage is 1659369304 and his current mailing address is 10202 Se 32nd Ave, Suite 201, Milwaukie, Oregon. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1659369304.
Physician's Profile
| Full Name | Donald W Fortlage |
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| Gender | Male |
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| Speciality | Pediatrics |
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| Location | 10202 Se 32nd Ave, Milwaukie, Oregon |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1659369304
- Provider Enumeration Date: 10/07/2005
- Last Update Date: 07/09/2007
Medical Identifiers
Medical identifiers for Donald W Fortlage such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1659369304 | NPI | - | NPPES |
| 062844 | Medicaid | OR | |
| D95253000001 | Other | OR | GOOD HEALTH PLAN |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 208000000X | Pediatrics | MD07219 (Oregon) | Primary |
| 208000000X | Pediatrics | MD00021724 (Washington) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Donald W Fortlage is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Donald W Fortlage,
10202 Se 32nd Ave, Suite 201,
Milwaukie, OR 97222-3610
Ph: (503) 653-0770 | Donald W Fortlage,
10202 Se 32nd Ave, Suite 201,
Milwaukie, OR 97222-3610
Ph: (503) 653-0770 |
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