Provider Demographics
NPI:1376036988
Name:ORTIZ, NETTER JACOBO (MD)
Entity Type:Individual
Prefix:DR
First Name:NETTER
Middle Name:JACOBO
Last Name:ORTIZ
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 1:2100 VILLAGE CENTER DR STE F1
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-1119
Mailing Address - Country:US
Mailing Address - Phone:956-525-7084
Mailing Address - Fax:956-525-7203
Practice Address - Street 1:2100 VILLAGE CENTER DR STE F1
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-1119
Practice Address - Country:US
Practice Address - Phone:956-525-7084
Practice Address - Fax:956-525-7203
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10063187207Q00000X
TXT3532207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty