Provider Demographics
NPI:1083612592
Name:ORTIZ, JORGE L (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:L
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:11400 VISTA DEL SOL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5319
Mailing Address - Country:US
Mailing Address - Phone:915-590-0662
Mailing Address - Fax:915-590-0262
Practice Address - Street 1:11400 VISTA DEL SOL DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5319
Practice Address - Country:US
Practice Address - Phone:915-590-0662
Practice Address - Fax:915-590-0262
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL7085208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160525501Medicaid
TX160526301Medicaid
TXH97671Medicare UPIN