Healthcare Provider Details

I. General information

NPI: 1063403202
Provider Name (Legal Business Name): WALTER CORTES ORTIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVDA FRAGOSO 3KS-5 VILLA FONTANA
CAROLINA PR
00983
US

IV. Provider business mailing address

PO BOX 9341
CAROLINA PR
00988-9341
US

V. Phone/Fax

Practice location:
  • Phone: 787-752-6500
  • Fax: 787-752-6444
Mailing address:
  • Phone: 787-752-6500
  • Fax: 787-752-6444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4043
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: