Healthcare Provider Details

I. General information

NPI: 1861470312
Provider Name (Legal Business Name): MARCOS R ORTEGA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 08/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5080 BAYOU BLVD
PENSACOLA FL
32503-2522
US

IV. Provider business mailing address

5080 BAYOU BLVD
PENSACOLA FL
32503-2522
US

V. Phone/Fax

Practice location:
  • Phone: 850-477-4074
  • Fax: 850-476-9234
Mailing address:
  • Phone: 850-477-4074
  • Fax: 850-476-9234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME84738
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: