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Organization
JORGE A. ONTIVEROS, M.D., P.A.
Active
Organization
JORGE A. ONTIVEROS, M.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JORGE ONTIVEROS M.D. (PRESIDENT)
(214) 533-8545
Entity
Organization
Contact information
Practice address
10705 PLANO RD, SUITE 200, DALLAS, TX 75238-5343
(214) 553-8545
(214) 553-9010
Mailing address
PO BOX 2024, ADDISON, TX 75001-2024
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
K7852
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0097QV
BCBS
TX
05
—
176862401
—
TX
01
—
DH1290
RR MEDICARE
TX
Enumeration date
02/27/2007
Last updated
05/29/2008
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