Provider Demographics
NPI:1114127446
Name:ORTEGA, AGNES (MD)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11809 AL HIGHWAY 157
Mailing Address - Street 2:SUITE E
Mailing Address - City:MOULTON
Mailing Address - State:AL
Mailing Address - Zip Code:35650-2707
Mailing Address - Country:US
Mailing Address - Phone:256-905-0340
Mailing Address - Fax:
Practice Address - Street 1:11809 AL HIGHWAY 157
Practice Address - Street 2:SUITE E
Practice Address - City:MOULTON
Practice Address - State:AL
Practice Address - Zip Code:35650-2707
Practice Address - Country:US
Practice Address - Phone:256-905-0340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29465207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology