Provider Demographics
NPI:1881682607
Name:ORTENBERG, JOSEPH MARK (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MARK
Last Name:ORTENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1300 W TERRELL AVE
Mailing Address - Street 2:#500
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2800
Mailing Address - Country:US
Mailing Address - Phone:817-252-5000
Mailing Address - Fax:817-252-5060
Practice Address - Street 1:1300 W TERRELL AVE
Practice Address - Street 2:#500
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2800
Practice Address - Country:US
Practice Address - Phone:817-252-5000
Practice Address - Fax:817-252-5060
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7365207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B2676OtherBLUE CROSS
TX8502N4OtherMEDICARE
TX8B2676OtherBLUE CROSS
TXG85881Medicare UPIN