Provider Demographics
NPI:1225240443
Name:ONTAI, SIDNEY CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:CHARLES
Last Name:ONTAI
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 1:501 E COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-6025
Mailing Address - Country:US
Mailing Address - Phone:361-579-8300
Mailing Address - Fax:361-579-8303
Practice Address - Street 1:501 E COLORADO ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6025
Practice Address - Country:US
Practice Address - Phone:361-579-8300
Practice Address - Fax:806-579-8303
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7364207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018373301Medicaid
TX120737101OtherFIRSTCARE INSURANCE ID
TX8G8750OtherBCBS TX
TX8G8750OtherBCBS TX
TXE69092Medicare UPIN
TXE69092Medicare UPIN