Provider Demographics
NPI:1437300126
Name:ORTIZ, GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JORGE
Other - Middle Name:
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 53
Mailing Address - Street 2:GEORGE A. ORTIZ
Mailing Address - City:MEACHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97859
Mailing Address - Country:US
Mailing Address - Phone:541-983-2680
Mailing Address - Fax:
Practice Address - Street 1:52908 CHIPPER LANE
Practice Address - Street 2:
Practice Address - City:MEACHAM
Practice Address - State:OR
Practice Address - Zip Code:97859
Practice Address - Country:US
Practice Address - Phone:541-983-2680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD09644207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine