Provider Demographics
NPI:1336109479
Name:ORTEGA, JOSE MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MANUEL
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 1:18955 N MEMORIAL DR STE 480
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4399
Mailing Address - Country:US
Mailing Address - Phone:281-319-5319
Mailing Address - Fax:281-319-4424
Practice Address - Street 1:18955 N MEMORIAL DR STE 480
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4399
Practice Address - Country:US
Practice Address - Phone:281-319-5319
Practice Address - Fax:281-319-4424
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4590208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138990002Medicaid
TX00162LMedicare ID - Type Unspecified