Basic Information
| Provider Information | |||||||||
| NPI: | 1467480376 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ORTSTADT | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7005 CORTEZ RD W | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342102509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417500602 | ||||||||
| FaxNumber: | 9417485626 | ||||||||
| Practice Location | |||||||||
| Address1: | 7005 CORTEZ RD W | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342102509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417500602 | ||||||||
| FaxNumber: | 9417485626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 12/30/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | G50462 | CA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | N3965 | TX | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | ME130283 | FL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 203608902 | 01 | TX | CSHCN | OTHER | 203608901 | 05 | TX | MEDICAID | 00G504620 | 05 | CA | MEDICAID |