Provider Demographics
NPI:1790946903
Name:ORTEGA LOAYZA, ALEX G (MD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:G
Last Name:ORTEGA LOAYZA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3303 SW BOND AVE
Mailing Address - Street 2:MAILCODE: CH16D
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4501
Mailing Address - Country:US
Mailing Address - Phone:503-494-3376
Mailing Address - Fax:503-346-8106
Practice Address - Street 1:3303 SW BOND AVE
Practice Address - Street 2:MAILCODE: CH16D
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4501
Practice Address - Country:US
Practice Address - Phone:503-494-3376
Practice Address - Fax:503-346-8106
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2016-03-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101255893207N00000X
ORMD175789207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology