Individual
ISMAEL ORTEGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1223 GATEWAY DR STE 2G, MELBOURNE, FL 32901-2607
(321) 312-3499
(321) 768-5082
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 312-3499
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME101029
FL
207RP1001X
Pulmonary Disease Physician
Primary
ME101029
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
281088301
—
FL
01
—
P01164163
RR MEDICARE
FL
Enumeration date
04/14/2008
Last updated
02/28/2020
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