MEDICARE: DANIEL LUIS ORTIZ D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	DO-753	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51000042	OTHER	AL	BLUE CROSS BLUE SHIELD P
2	51507726	OTHER	AL	BC/BS OF AL PROVIDER #

General Provider Information

NPI Number	:	1023102126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL LUIS ORTIZ D.O.

Provider Business Mailing Address
First Line	:	406 TAYLOR ST STE B
Second Line	:
City	:	SCOTTSBORO
State	:	AL
Zip	:	35768-2406
Country	:	US
Telephone Number	:	256-574-6100
Fax Number	:	256-574-3004

Provider Business Practice Location Address
First Line	:	406 TAYLOR ST STE B
Second Line	:
City	:	SCOTTSBORO
State	:	AL
Zip	:	35768-2406
Country	:	US
Telephone Number	:	256-574-6100
Fax Number	:	256-574-3004

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	03/22/2026

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