Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | ACN963 | FL |
NPI | 1003354184 |
---|---|
Provider Name | Dr. Juan Felipe Ortiz |
First Address | Tampa, FL 33603-2603 |
Second Address | Tampa, FL 33603-2603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2017 |
Last Update Date | 23/01/2020 |