Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | AT0820 | TX |
NPI | 1154922755 |
---|---|
Provider Name | Mr. David Conrad Ortmeier |
First Address | Northlake, TX 76226-2729 |
Second Address | Flower Mound, TX 75022-5628 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2020 |
Last Update Date | 02/11/2020 |