Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | R76009 | AZ |
N | 111NI0900X | Internist | R76009 | AZ |
Y | 207RA0201X | Internist - Allergy & Immunology | R76009 | AZ |
NPI | 1003349242 |
---|---|
Provider Name | Gilbert Ortega |
First Address | Dallas, TX 75390-8859 |
Second Address | Dallas, TX 75390-8859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2017 |
Last Update Date | 19/05/2020 |