Healthcare Provider Details

I. General information

NPI: 1114960168
Provider Name (Legal Business Name): GILBERT R ORTEGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 N SCOTTSDALE RD SUITE 142
SCOTTSDALE AZ
85251-5648
US

IV. Provider business mailing address

PO BOX 52457 DEPT 3024
PHOENIX AZ
85072-2457
US

V. Phone/Fax

Practice location:
  • Phone: 480-874-2040
  • Fax: 480-874-2041
Mailing address:
  • Phone: 480-874-2040
  • Fax: 480-874-2041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number34778
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: