MEDICARE: ENRIQUE M ORTEGA M.D.

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	207V00000X	Obstetrics & Gynecology Physician	J2969	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	88009G	OTHER	TX	BLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number	:	1174525455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENRIQUE M ORTEGA M.D.

Provider Business Mailing Address
First Line	:	6031 AIRLINE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77076-4209
Country	:	US
Telephone Number	:	713-694-6600
Fax Number	:	713-694-6616

Provider Business Practice Location Address
First Line	:	6031 AIRLINE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77076-4209
Country	:	US
Telephone Number	:	713-694-6600
Fax Number	:	713-694-6616

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	06/12/2012

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Directions to “ ENRIQUE M ORTEGA M.D.” Practice Location

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