Provider Demographics
NPI:1689759029
Name:ORTIZ, JOSEPH EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:EDWARD
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4351 E LOHMAN AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011
Mailing Address - Country:US
Mailing Address - Phone:505-522-4767
Mailing Address - Fax:505-522-3607
Practice Address - Street 1:4351 E. LOHMAN AVENUE
Practice Address - Street 2:SUITE 401
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011
Practice Address - Country:US
Practice Address - Phone:505-522-4767
Practice Address - Fax:505-522-3607
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM2003-0461207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM54632064Medicaid
NM002M08OtherBLUECROSS BLUESHIELD
NM5333075OtherAETNA
NM600521042OtherGROUP PTAN
NM202018798OtherPRESBYTERIAN
NM202018798OtherPRESBYTERIAN
NMH94435Medicare UPIN