Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 29465 | AL |
NPI | 1114127446 |
---|---|
Provider Name | Agnes Ortega |
First Address | Moulton, AL 35650-2707 |
Second Address | Moulton, AL 35650-2707 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2007 |
Last Update Date | 11/08/2011 |