Provider Demographics
NPI:1346236940
Name:ORTELL, EDWARD BRIAN (DO)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:BRIAN
Last Name:ORTELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-6413
Mailing Address - Country:US
Mailing Address - Phone:641-684-2927
Mailing Address - Fax:641-684-2926
Practice Address - Street 1:1005 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-6413
Practice Address - Country:US
Practice Address - Phone:641-684-2927
Practice Address - Fax:641-684-2926
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3557208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA34520OtherWELLMARK INC BCBS OF IA
IA212484OtherIA HEALTH SOLUTIONS
IA420681060B5OtherJOHN DEERE HEALTH
IAP00052611OtherRAILROAD MEDICARE
IAH005OtherTRIWEST
IA1267864Medicaid
H25699Medicare UPIN
I10034Medicare ID - Type Unspecified