Healthcare Provider Details

I. General information

NPI: 1982921086
Provider Name (Legal Business Name): LUIS ENRIQUE ORTIZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 5TH ST S
ST PETERSBURG FL
33701
US

IV. Provider business mailing address

601 5TH ST S
ST PETERSBURG FL
33701-4804
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-8480
  • Fax: 727-767-8420
Mailing address:
  • Phone: 410-955-2035
  • Fax: 410-955-1030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberME136968
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberME136968
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License NumberME136968
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: