Provider Demographics
NPI:1710911243
Name:ORTIZ, LUIS ARIEL (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ARIEL
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LUIS
Other - Middle Name:ARIEL
Other - Last Name:ORTIZ TORRES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:800-480-5243
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:3941 TAMIAMI TRL UNIT 3175
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-7925
Practice Address - Country:US
Practice Address - Phone:941-564-7160
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13942208D00000X
FLACN563208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLACN 563OtherFLORIDA TEMPORARY ACN LICENSE
PR13942OtherSTATE MEDICAL LICENSE
PR14108-5OtherASSMCA LICENSE
FLACN 563OtherFLORIDA TEMPORARY ACN LICENSE
PRBO7411490OtherDEA
FLID058WMedicare PIN
FLACN 563OtherFLORIDA TEMPORARY ACN LICENSE
FLID058XMedicare PIN
FLID058VMedicare PIN