Provider Demographics
NPI:1386602266
Name:ORDONEZ, JULIO A (MD)
Entity type:Individual
Prefix:DR
First Name:JULIO
Middle Name:A
Last Name:ORDONEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24900 SE STARK ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3355
Mailing Address - Country:US
Mailing Address - Phone:503-665-5522
Mailing Address - Fax:503-665-8822
Practice Address - Street 1:24900 SE STARK
Practice Address - Street 2:SUITE 209
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3382
Practice Address - Country:US
Practice Address - Phone:503-665-5522
Practice Address - Fax:503-665-8822
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD11164207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR169209OtherMEDICARE PROVIDER TRANSACTION ACCESS NUMBER (PTAN)
OR192138Medicaid
ORR169209OtherMEDICARE PROVIDER TRANSACTION ACCESS NUMBER (PTAN)