Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | DO-753 | AL |
NPI | 1023102126 |
---|---|
Provider Name | Daniel Luis Ortiz |
First Address | Scottsboro, AL 35768-2406 |
Second Address | Scottsboro, AL 35768-2406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
51000042 | BLUE CROSS BLUE SHIELD P (01) | AL |
51507726 | BC/BS OF AL PROVIDER # (01) | AL |
G37562 | (02) |