Provider Demographics
NPI:1215294749
Name:ORTIZ, JACOB ROBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:ROBERTO
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1215 LEE ST # 800158
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908-0816
Mailing Address - Country:US
Mailing Address - Phone:434-243-1000
Mailing Address - Fax:434-244-7551
Practice Address - Street 1:3333 SILAS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3013
Practice Address - Country:US
Practice Address - Phone:336-718-8383
Practice Address - Fax:336-718-9622
Is Sole Proprietor?:No
Enumeration Date:2012-04-22
Last Update Date:2024-06-23
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Provider Licenses
StateLicense IDTaxonomies
VA0101280647207RC0000X
NC2024-00383207RC0200X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist