Provider Demographics
NPI:1912974833
Name:ORTEGA, JOSE OCTAVIO (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:OCTAVIO
Last Name:ORTEGA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:805 SAINT VINCENTS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1636
Mailing Address - Country:US
Mailing Address - Phone:205-939-3699
Mailing Address - Fax:205-484-2585
Practice Address - Street 1:805 SAINT VINCENTS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1636
Practice Address - Country:US
Practice Address - Phone:205-939-3699
Practice Address - Fax:205-484-2585
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21877207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009912671Medicaid
AL51521092OtherBCBS
AL51006177OtherBCBS
AL051559051Medicare PIN
AL51521092OtherBCBS
051509974Medicare ID - Type Unspecified
ALL238Medicare PIN