Basic Information
| Provider Information | |||||||||
| NPI: | 1043346109 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORTALDO | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5080 SPECTRUM DR | ||||||||
| Address2: | SUITE 1200 WEST | ||||||||
| City: | ADDISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750014648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723648000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7400 W OLIVE AVE | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853458889 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6234878598 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2007 | ||||||||
| LastUpdateDate: | 01/21/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 31573 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 31573 | 01 | AZ | STATE LICENSE NUMBER | OTHER |