Provider Demographics
NPI:1093901316
Name:OTONIEL HUERTAS M.D.
Entity type:Organization
Organization Name:OTONIEL HUERTAS M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OTONIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUERTAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-279-9000
Mailing Address - Street 1:7557 RAMBLER RD
Mailing Address - Street 2:STE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4142
Mailing Address - Country:US
Mailing Address - Phone:972-279-9000
Mailing Address - Fax:972-279-9008
Practice Address - Street 1:7557 RAMBLER RD
Practice Address - Street 2:STE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4142
Practice Address - Country:US
Practice Address - Phone:972-279-9000
Practice Address - Fax:972-279-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9806207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F6103OtherMEDICARE PTAN INDIVIDUAL
TX00Y123OtherGROUP PTAN