Provider Demographics
NPI:1285682930
Name:ORTIZ, ALAIN RENE (MD)
Entity type:Individual
Prefix:
First Name:ALAIN
Middle Name:RENE
Last Name:ORTIZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14055 RIVEREDGE DR STE 250
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33637-2141
Mailing Address - Country:US
Mailing Address - Phone:813-929-5451
Mailing Address - Fax:813-929-5465
Practice Address - Street 1:14055 RIVEREDGE DR STE 250
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33637-2141
Practice Address - Country:US
Practice Address - Phone:813-929-5451
Practice Address - Fax:813-929-5465
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME922542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I13620Medicare UPIN
FLU6386Medicare ID - Type Unspecified