Donald W. Fortlage

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD07219 Issued in OR

Practice address

10202 SE 32ND Ave
Suite 201
Milwaukie, OR 97222-3610

Phone

(503) 653-0770

Fax

(503) 653-0844

NPI assigned

Oct 7, 2005

Last updated

Jul 13, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Dr. Donald W Fortlage Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1659369304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10202 SE 32ND AVE",
            "address_2": "SUITE 201",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972223610",
            "telephone_number": "503-653-0770",
            "fax_number": "503-653-0844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10202 SE 32ND AVE",
            "address_2": "SUITE 201",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972223610",
            "telephone_number": "503-653-0770",
            "fax_number": "503-653-0844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTLAGE",
        "first_name": "DONALD",
        "middle_name": "W.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-07",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "MD07219",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD00021724",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "062844",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GOOD HEALTH PLAN",
            "identifier": "D95253000001",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DONALD",
            "last_name": "FORTLAGE",
            "middle_name": "W",
            "prefix": "DR.",
            "credential": "M.D., F.A.A.P.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Pediatrics Physician in Milwaukie, OR
• Providers in Milwaukie, OR by specialty
• Pediatrics Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.