Provider Demographics
NPI:1811989569
Name:ORTIZ, FELIPE O (MD)
Entity type:Individual
Prefix:DR
First Name:FELIPE
Middle Name:O
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-7324
Mailing Address - Country:US
Mailing Address - Phone:352-728-0709
Mailing Address - Fax:352-728-6460
Practice Address - Street 1:501 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 102
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-7324
Practice Address - Country:US
Practice Address - Phone:352-728-0709
Practice Address - Fax:352-728-6460
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074213207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253650100Medicaid
FLK0026OtherGROUP NUMBER
FL42383OtherBLUE SHIELD
FL252861400Medicaid
FL42383Medicare PIN
FL42383OtherBLUE SHIELD