Provider Demographics
NPI:1740232149
Name:ORTIZ, DENNIS L (DO)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:L
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4218 GATEWAY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034
Mailing Address - Country:US
Mailing Address - Phone:817-283-1860
Mailing Address - Fax:817-283-2175
Practice Address - Street 1:4218 GATEWAY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034
Practice Address - Country:US
Practice Address - Phone:817-283-1860
Practice Address - Fax:817-283-2175
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0705208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170333203Medicaid
340019907OtherRAIL ROAD MEDICARE
P00153491OtherRAIL ROAD MEDICARE
TX170333201Medicaid
TX170333202Medicaid
TX170333201Medicaid
TX170333202Medicaid
A67467Medicare UPIN
TX170333203Medicaid