Provider Demographics
NPI:1114960168
Name:ORTEGA, GILBERT R (MD)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:R
Last Name:ORTEGA
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 52457 DEPT 3024
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85072-2457
Mailing Address - Country:US
Mailing Address - Phone:480-874-2040
Mailing Address - Fax:480-874-2041
Practice Address - Street 1:3501 N SCOTTSDALE RD
Practice Address - Street 2:SUITE 142
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5648
Practice Address - Country:US
Practice Address - Phone:480-874-2040
Practice Address - Fax:480-874-2041
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34778207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ066282Medicaid
AZI55089Medicare UPIN
AZ066282Medicaid