Provider Demographics
NPI:1982663068
Name:DORTA, JOSE NELSON (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:NELSON
Last Name:DORTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:NELSON
Other - Last Name:DORTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 986
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-0986
Mailing Address - Country:US
Mailing Address - Phone:337-363-6413
Mailing Address - Fax:337-363-1777
Practice Address - Street 1:421 JACK MILLER RD
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-5635
Practice Address - Country:US
Practice Address - Phone:337-363-6413
Practice Address - Fax:337-363-1777
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10932R207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1996661Medicaid
LA5U776Medicare ID - Type Unspecified