Provider Demographics
NPI:1285612721
Name:TEODORO K. ORTEGA, M.D., P.A.
Entity type:Organization
Organization Name:TEODORO K. ORTEGA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TEODORO
Authorized Official - Middle Name:K
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-477-4074
Mailing Address - Street 1:5080 BAYOU BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2522
Mailing Address - Country:US
Mailing Address - Phone:850-477-4074
Mailing Address - Fax:850-476-9234
Practice Address - Street 1:5080 BAYOU BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2522
Practice Address - Country:US
Practice Address - Phone:850-477-4074
Practice Address - Fax:850-476-9234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34307Medicare PIN