Provider Demographics
NPI:1467480376
Name:ORTSTADT, JEFFREY L (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:ORTSTADT
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 1:7005 CORTEZ RD W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-2509
Mailing Address - Country:US
Mailing Address - Phone:941-750-0602
Mailing Address - Fax:941-748-5626
Practice Address - Street 1:7005 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-2509
Practice Address - Country:US
Practice Address - Phone:941-750-0602
Practice Address - Fax:941-748-5626
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG504622084N0400X
TXN39652084N0400X
FLME1302832084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203608902OtherCSHCN
TX203608901Medicaid
CA00G504620Medicaid
TX203608901Medicaid
TX8L15945Medicare PIN
CA00G504620Medicaid