MEDICARE: DR. MARTIN ORTIZ 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	174400000X	Specialist	5348	PR

General Provider Information

NPI Number	:	1487661146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN ORTIZ MD

Provider Business Mailing Address
First Line	:	PO BOX 640
Second Line	:
City	:	PUERTO REAL
State	:	PR
Zip	:	00740-0640
Country	:	US
Telephone Number	:	787-763-8932
Fax Number	:	787-763-8533

Provider Business Practice Location Address
First Line	:	562 CALLE JUAN J JIMENEZ
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3722
Country	:	US
Telephone Number	:	787-763-8932
Fax Number	:	787-763-8533

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	07/09/2007

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