Provider Demographics
NPI:1710985502
Name:ORTIZ, EDGARDO J (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGARDO
Middle Name:J
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EDGARDO
Other - Middle Name:J
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2431 AVE LAS AMERICAS
Mailing Address - Street 2:A. PORRATA PILA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2114
Mailing Address - Country:US
Mailing Address - Phone:787-840-7230
Mailing Address - Fax:787-848-7648
Practice Address - Street 1:2431 AVE LAS AMERICAS
Practice Address - Street 2:A. PORRATA PILA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2113
Practice Address - Country:US
Practice Address - Phone:787-840-7230
Practice Address - Fax:787-848-7648
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6882174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD26715Medicare UPIN
PR98535Medicare ID - Type UnspecifiedMEDICARE