Provider Demographics
NPI:1497147276
Name:ORTHO EL PASO
Entity Type:Organization
Organization Name:ORTHO EL PASO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:VOURAZERIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-249-4000
Mailing Address - Street 1:12770 EDGEMERE BLVD.
Mailing Address - Street 2:BLDG. F.
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-3331
Mailing Address - Country:US
Mailing Address - Phone:915-249-4000
Mailing Address - Fax:915-206-5949
Practice Address - Street 1:12770 EDGEMERE BLVD
Practice Address - Street 2:BUILDING F
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-4568
Practice Address - Country:US
Practice Address - Phone:915-249-4000
Practice Address - Fax:915-206-5949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ1531207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty