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General NPI Number Information
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NPI Number | 1508993791
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Entity Type | Organization
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Legal Business Name | JORGE A. ONTIVEROS, M.D., P.A.
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 10705 PLANO RD SUITE 200
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City | DALLAS
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State | TX
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Zip | 75238-5343
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Country | US
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Telephone | 214-553-8545
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Fax | 214-553-9010
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Provider Business Mailing Address
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Address Line | PO BOX 2024
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City | ADDISON
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State | TX
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Zip | 75001-2024
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JORGE ONTIVEROS
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Credential | M.D.
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Telephone | 214-533-8545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | K7852
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License Number State | TX
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