MEDICARE: ISMAEL ORTEGO JAMORA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	10222	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000504	OTHER	WV	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	550737600	OTHER	WV	COMMERICAL INSURANCE

General Provider Information

NPI Number	:	1033217914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISMAEL ORTEGO JAMORA MD

Provider Business Mailing Address
First Line	:	PO BOX 236
Second Line	:
City	:	PT PLEASANT
State	:	WV
Zip	:	25550-0236
Country	:	US
Telephone Number	:	304-675-5188
Fax Number	:	304-675-5893

Provider Business Practice Location Address
First Line	:	2520 VALLEY DR
Second Line	:	SUITE # 116
City	:	PT PLEASANT
State	:	WV
Zip	:	25550-2031
Country	:	US
Telephone Number	:	304-675-5188
Fax Number	:	304-675-3811

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	12/10/2009

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Directions to “ ISMAEL ORTEGO JAMORA MD” Practice Location

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