Provider Demographics
NPI:1316053754
Name:CONRADO J ORDONEZ MD PA
Entity type:Organization
Organization Name:CONRADO J ORDONEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CONRADO
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:ORDONEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-238-0443
Mailing Address - Street 1:5633 AVENUE I
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-6191
Mailing Address - Country:US
Mailing Address - Phone:281-238-0443
Mailing Address - Fax:281-238-0899
Practice Address - Street 1:5633 AVENUE I
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-6191
Practice Address - Country:US
Practice Address - Phone:281-238-0443
Practice Address - Fax:281-238-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130913005Medicaid
F86906Medicare UPIN
TX00547GMedicare PIN