MEDICARE: TARA K 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	208800000X	Urology Physician	S1882	TX

General Provider Information

NPI Number	:	1669767240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA K ORTIZ MD

Provider Business Mailing Address
First Line	:	249 SPORTSPLEX DR STE 204
Second Line	:
City	:	DRIPPING SPRINGS
State	:	TX
Zip	:	78620-2350
Country	:	US
Telephone Number	:	512-324-9570
Fax Number	:	512-324-9573

Provider Business Practice Location Address
First Line	:	249 SPORTSPLEX DR STE 204
Second Line	:
City	:	DRIPPING SPRINGS
State	:	TX
Zip	:	78620-2350
Country	:	US
Telephone Number	:	512-324-9570
Fax Number	:	512-324-9573

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

Provider Enumeration Date	:	06/13/2011
Last Update Date	:	05/18/2026

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