Provider Demographics
NPI:1720043060
Name:ORTIZ, ALBERTO (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ALBERTO
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 REGIONAL MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-9719
Mailing Address - Country:US
Mailing Address - Phone:979-532-1700
Mailing Address - Fax:979-532-6792
Practice Address - Street 1:2100 REGIONAL MEDICAL DR
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-9719
Practice Address - Country:US
Practice Address - Phone:979-532-1700
Practice Address - Fax:979-532-6792
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01220363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01090522OtherRAILROAD MEDICARE PTAN
TX875N32OtherBC/BS #
TX990005691OtherRAILROAD GBA - RAILROAD MEDICARE
TX306211902Medicaid
TXP01090522OtherRAILROAD MEDICARE PTAN
TXR88634Medicare UPIN
TX306211902Medicaid