Provider Demographics
NPI:1588754006
Name:ORDONEZ, TIFFANY M (MD)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:M
Last Name:ORDONEZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:M
Other - Last Name:FONTE-ORDONEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:NATURITA
Mailing Address - State:CO
Mailing Address - Zip Code:81422-0340
Mailing Address - Country:US
Mailing Address - Phone:970-865-2665
Mailing Address - Fax:970-865-2674
Practice Address - Street 1:421 ADAMS ST
Practice Address - Street 2:
Practice Address - City:NATURITA
Practice Address - State:CO
Practice Address - Zip Code:81422-5018
Practice Address - Country:US
Practice Address - Phone:970-865-2665
Practice Address - Fax:970-865-2674
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC176004207R00000X
CO42328207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO379832ZJGQOtherMEDICARE B PTAN FOR BASIN CLINIC
CO06780342Medicaid
CO06780342Medicaid