Provider Demographics
NPI:1154922755
Name:ORTMEIER, DAVID CONRAD (LAT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CONRAD
Last Name:ORTMEIER
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 MONARCH TRL
Mailing Address - Street 2:
Mailing Address - City:NORTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-2729
Mailing Address - Country:US
Mailing Address - Phone:214-449-8759
Mailing Address - Fax:
Practice Address - Street 1:4900 WICHITA TRL
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-5628
Practice Address - Country:US
Practice Address - Phone:682-237-0232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT0820207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine