Provider Demographics
NPI:1720037989
Name:ORTEGA, GREGORY L (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:L
Last Name:ORTEGA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2776 ENTERPRISE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8316
Mailing Address - Country:US
Mailing Address - Phone:386-774-1223
Mailing Address - Fax:386-774-4658
Practice Address - Street 1:2776 ENTERPRISE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8316
Practice Address - Country:US
Practice Address - Phone:386-774-1223
Practice Address - Fax:386-774-4658
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2017-12-14
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Provider Licenses
StateLicense IDTaxonomies
FLME41521207RH0003X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL04489740Medicaid
FL08338ZMedicare PIN
FLA63341Medicare UPIN