Provider Demographics
NPI:1144321829
Name:ORTIZ-BUTCHER, CARMEN J (MD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:J
Last Name:ORTIZ-BUTCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 CRANDON BLVD
Mailing Address - Street 2:SUITE 967
Mailing Address - City:KEY BISCOYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149
Mailing Address - Country:US
Mailing Address - Phone:305-365-8222
Mailing Address - Fax:305-365-8299
Practice Address - Street 1:971 CRANDON BLVD
Practice Address - Street 2:SUITE 967
Practice Address - City:KEY BISCAYNE
Practice Address - State:FL
Practice Address - Zip Code:33149
Practice Address - Country:US
Practice Address - Phone:305-365-8222
Practice Address - Fax:305-365-8299
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045129207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96816OtherBLUE CROSS BLUE SHIELD FL
FL042514100Medicaid
FL27105OtherNHP
FL96816AMedicare PIN
FLD082654Medicare UPIN