Provider Demographics
NPI:1871912477
Name:ORTIZ, DANIEL ENRIQUE (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ENRIQUE
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 100238
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0238
Mailing Address - Country:US
Mailing Address - Phone:352-294-8278
Mailing Address - Fax:352-265-0379
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-1804
Practice Address - Country:US
Practice Address - Phone:352-294-8278
Practice Address - Fax:352-265-0379
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA140697208M00000X
FLME141794207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104234400Medicaid