Healthcare Provider Details

I. General information

NPI: 1841309176
Provider Name (Legal Business Name): DONALD J ORTIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/29/2026
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 CARLISLE BLVD NE MIDTOWN FAMILY MEDICINE
ALBUQUERQUE NM
87110-4905
US

IV. Provider business mailing address

PO BOX 26028
ALBUQUERQUE NM
87125-6028
US

V. Phone/Fax

Practice location:
  • Phone: 505-255-1228
  • Fax: 505-255-1394
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number92-323
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number92-323
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: