Healthcare Provider Details

I. General information

NPI: 1467439174
Provider Name (Legal Business Name): NARMO LUIS ORTIZ JR. D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 PATTERSON RD STE 3
HAINES CITY FL
33844-6261
US

IV. Provider business mailing address

280 PATTERSON RD STE 3
HAINES CITY FL
33844-6261
US

V. Phone/Fax

Practice location:
  • Phone: 863-422-2356
  • Fax: 863-547-8903
Mailing address:
  • Phone: 863-422-2356
  • Fax: 863-547-8903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number762
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO2522
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: