Provider Demographics
NPI:1023102126
Name:ORTIZ, DANIEL LUIS (DO)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:LUIS
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 TAYLOR ST STE B
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-2406
Mailing Address - Country:US
Mailing Address - Phone:256-574-6100
Mailing Address - Fax:256-574-3004
Practice Address - Street 1:406 TAYLOR ST STE B
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2406
Practice Address - Country:US
Practice Address - Phone:256-574-6100
Practice Address - Fax:256-574-3004
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO-753207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51000042OtherBLUE CROSS BLUE SHIELD P
AL51507726OtherBC/BS OF AL PROVIDER #
AL51507726OtherBC/BS OF AL PROVIDER #
G37562Medicare UPIN