Provider Demographics
NPI:1760716872
Name:GONZALEZ-ORTIZ, HIRAM ALEXIS (MD)
Entity Type:Individual
Prefix:DR
First Name:HIRAM
Middle Name:ALEXIS
Last Name:GONZALEZ-ORTIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:800 PLAZA DR STE 140
Mailing Address - Street 2:
Mailing Address - City:ROSTRAVER TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15012-4019
Mailing Address - Country:US
Mailing Address - Phone:724-929-4122
Mailing Address - Fax:724-929-5188
Practice Address - Street 1:800 PLAZA DR STE 140
Practice Address - Street 2:
Practice Address - City:ROSTRAVER TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15012-4019
Practice Address - Country:US
Practice Address - Phone:724-929-4122
Practice Address - Fax:724-929-5188
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD445978208600000X
WI55661208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery