Provider Demographics
NPI:1568446342
Name:ORDAZ, FERNANDO EDMUND (MD)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:EDMUND
Last Name:ORDAZ
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 1:7102 WOOD BRIAR RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-6200
Mailing Address - Country:US
Mailing Address - Phone:502-648-5700
Mailing Address - Fax:
Practice Address - Street 1:650 JOEL DR
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5318
Practice Address - Country:US
Practice Address - Phone:270-461-1563
Practice Address - Fax:270-461-4529
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25261207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64252612Medicaid
KY64252612Medicaid
KY1501501Medicare ID - Type UnspecifiedMEDICARE NUMBER