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General NPI Number Information
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NPI Number | 1154922755
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Entity Type | Individual
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Provider Name | DAVID CONRAD ORTMEIER LAT
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Gender | Male
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Dates
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Enumeration Date | 11/02/2020
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 4900 WICHITA TRL
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City | FLOWER MOUND
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State | TX
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Zip | 75022-5628
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Country | US
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Telephone | 682-237-0232
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Fax |
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Provider Business Mailing Address
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Address Line | 1427 MONARCH TRL
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City | NORTHLAKE
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State | TX
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Zip | 76226-2729
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Country | US
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Telephone | 214-449-8759
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | AT0820
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License Number State | TX
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