Provider Demographics
NPI:1467549873
Name:ORTIZ, RAYNALDO RIVERA JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYNALDO
Middle Name:RIVERA
Last Name:ORTIZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAY
Other - Middle Name:
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1721 ANALOG DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-1944
Mailing Address - Country:US
Mailing Address - Phone:972-276-6100
Mailing Address - Fax:972-276-1231
Practice Address - Street 1:700 WALTER REED BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-3701
Practice Address - Country:US
Practice Address - Phone:972-276-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9000207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133668710Medicaid
TX8F1249Medicare ID - Type UnspecifiedGV MCARE ID
TX133668710Medicaid
TXF55898Medicare UPIN
TX8B6898Medicare ID - Type UnspecifiedGAC MC ID