Provider Demographics
NPI:1932105905
Name:ORTEGA DELAGARZA, GERARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:
Last Name:ORTEGA DELAGARZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 N MAIN AVE
Mailing Address - Street 2:2ND FLOOR ADMINISTRATION
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-1204
Mailing Address - Country:US
Mailing Address - Phone:210-237-4444
Mailing Address - Fax:210-828-0590
Practice Address - Street 1:610 N MAIN AVENUE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2014
Practice Address - Country:US
Practice Address - Phone:210-225-6508
Practice Address - Fax:210-225-1486
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG07832086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117278501Medicaid
TX81A604Medicare ID - Type Unspecified
TX117278501Medicaid