Provider Demographics
NPI:1376742833
Name:ORTEGA, JOSE AGUSTIN III (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:AGUSTIN
Last Name:ORTEGA
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3450 LANTANA RD
Mailing Address - Street 2:STE100
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1304
Mailing Address - Country:US
Mailing Address - Phone:561-965-1864
Mailing Address - Fax:561-967-5005
Practice Address - Street 1:3450 LANTANA RD
Practice Address - Street 2:STE100
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33462-1304
Practice Address - Country:US
Practice Address - Phone:561-965-1864
Practice Address - Fax:561-967-5005
Is Sole Proprietor?:No
Enumeration Date:2007-07-15
Last Update Date:2015-01-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 100365207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000065900Medicaid
FL000065900Medicaid