Provider Demographics
NPI:1831327360
Name:ORTIGOZA, ERIC BRUM (MD, MSCR)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:BRUM
Last Name:ORTIGOZA
Suffix:
Gender:M
Credentials:MD, MSCR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-648-3903
Mailing Address - Fax:214-648-2481
Practice Address - Street 1:5323 HARRY HINES BOULEVARD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7208
Practice Address - Country:US
Practice Address - Phone:214-648-3903
Practice Address - Fax:214-648-2481
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003993208000000X
FLME112378208000000X, 2080N0001X
SCLL32374208000000X
TXQ37532080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics