Provider Demographics
NPI:1497708754
Name:ORTIZ, RAYMOND F (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:F
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2515 RIDGE RUNNER RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4972
Mailing Address - Country:US
Mailing Address - Phone:505-425-2662
Mailing Address - Fax:505-425-6410
Practice Address - Street 1:2515 RIDGE RUNNER RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4972
Practice Address - Country:US
Practice Address - Phone:505-426-8010
Practice Address - Fax:505-454-0322
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM85-77207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMT9915Medicaid
NM446831YUVAMedicare PIN
NMD35869Medicare UPIN