Basic Information
| Provider Information | |||||||||
| NPI: | 1043249493 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ORTEGA | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | ELAINE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1220 W WILLOW RD | ||||||||
| Address2: | STE C | ||||||||
| City: | ENID | ||||||||
| State: | OK | ||||||||
| PostalCode: | 737032511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802423003 | ||||||||
| FaxNumber: | 5802333279 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 S MONROE ST | ||||||||
| Address2: | |||||||||
| City: | ENID | ||||||||
| State: | OK | ||||||||
| PostalCode: | 737017211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802332300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 14338 | OK | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.