Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN23064 | FL |
N | 204E00000X | Oral & Maxillofacial Surgeon | D-10615 | MA |
NPI | 1497984785 |
---|---|
Provider Name | Ricardo M Ortiz |
First Address | Tallahassee, FL 32311-7894 |
Second Address | Tallahassee, FL 32311-7894 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2009 |
Last Update Date | 04/06/2021 |