Provider Demographics
NPI:1235190331
Name:ORTIZ, JESUS J (MD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:J
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1199 W LANTANA RD
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1514
Mailing Address - Country:US
Mailing Address - Phone:561-540-3747
Mailing Address - Fax:561-540-3727
Practice Address - Street 1:1199 W LANTANA RD
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-1514
Practice Address - Country:US
Practice Address - Phone:561-540-3747
Practice Address - Fax:561-540-3727
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME673462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF91104Medicare UPIN