Provider Demographics
NPI:1194757302
Name:ORTA, DAVID ALFREDO JR (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALFREDO
Last Name:ORTA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12035 SW 126 ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186
Mailing Address - Country:US
Mailing Address - Phone:786-242-4250
Mailing Address - Fax:
Practice Address - Street 1:7500 SW 8 ST
Practice Address - Street 2:SUITE 209
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144
Practice Address - Country:US
Practice Address - Phone:305-262-6296
Practice Address - Fax:305-262-4176
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME25215207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037598500Medicaid
FL037598500Medicaid
FL92711Medicare ID - Type Unspecified