Provider Demographics
NPI:1134157522
Name:ORTIZ, JOSE CLEMENTE JR (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:CLEMENTE
Last Name:ORTIZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:C
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2961 MOSSROCK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5119
Mailing Address - Country:US
Mailing Address - Phone:210-731-4800
Mailing Address - Fax:210-731-4810
Practice Address - Street 1:530 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5006
Practice Address - Country:US
Practice Address - Phone:210-225-4511
Practice Address - Fax:210-225-4514
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1279207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00871880OtherRAIL ROAD MEDICARE
TX177534801Medicaid
TX177534802Medicaid
TX611918Medicare PIN
TX8F24088Medicare PIN
TX177534801Medicaid