Provider Demographics
NPI:1225006091
Name:ORTIZ, KAREN A (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:ORTIZ
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 1:3461 SUMMIT SKY BLVD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-6278
Mailing Address - Country:US
Mailing Address - Phone:541-484-5437
Mailing Address - Fax:541-343-7360
Practice Address - Street 1:995 WILLAGILLESPIE RD STE 100A
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2251
Practice Address - Country:US
Practice Address - Phone:541-484-5437
Practice Address - Fax:541-343-7360
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2005-807208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM68270372Medicaid
NMNMA100332Medicare PIN
10023916OtherLOVELACE
5240260OtherCCN
QMYPR0070863OtherMOLINA HEALTHCARE
H38229Medicare UPIN
NMNM009X30OtherBCBS NM