Provider Demographics
NPI:1770780017
Name:ORTIZ-ALVARADO, OMAR (MD)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:ORTIZ-ALVARADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:1725 N UNIVERSITY DR
Practice Address - Street 2:SUITE 400
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6089
Practice Address - Country:US
Practice Address - Phone:954-752-3166
Practice Address - Fax:954-753-5628
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR17006208800000X
FLME107677208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9388235OtherAETNA
FL4943855OtherCIGNA
FLP971580OtherOPTIMUM
FLP01604622OtherRR MEDICARE
FL1256816OtherWELLCARE
FLQMP00005151201OtherMOLINA
FL389716OtherAVMED
FL14412OtherDIMENSION HEALTH
FL8ELTJOtherBCBS
FLP1035830OtherFREEDOM
FLP971580OtherOPTIMUM