Provider Demographics
NPI:1033217914
Name:JAMORA, ISMAEL ORTEGO (MD)
Entity Type:Individual
Prefix:
First Name:ISMAEL
Middle Name:ORTEGO
Last Name:JAMORA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:PT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550-0236
Mailing Address - Country:US
Mailing Address - Phone:304-675-5188
Mailing Address - Fax:304-675-5893
Practice Address - Street 1:2520 VALLEY DR
Practice Address - Street 2:SUITE # 116
Practice Address - City:PT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-2031
Practice Address - Country:US
Practice Address - Phone:304-675-5188
Practice Address - Fax:304-675-3811
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV10222207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000000504OtherBCBS
WV0076037000Medicaid
OH0222664Medicaid
WV550737600OtherCOMMERICAL INSURANCE
WV000000504OtherBCBS