Provider Demographics
NPI:1679647853
Name:ORTIZ, JULIO ENRIQUE (MD)
Entity Type:Individual
Prefix:
First Name:JULIO
Middle Name:ENRIQUE
Last Name:ORTIZ
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 1:13109 HUNTERS LEDGE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2047
Mailing Address - Country:US
Mailing Address - Phone:210-957-9100
Mailing Address - Fax:210-492-9325
Practice Address - Street 1:13109 HUNTERS LEDGE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-2047
Practice Address - Country:US
Practice Address - Phone:210-492-7766
Practice Address - Fax:210-492-9325
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE51972086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00H13FOtherBCBSTX
TX089690402Medicaid
TX00H13FMedicare ID - Type Unspecified
TXE99844Medicare UPIN