Provider Demographics
NPI:1043506777
Name:ORDONEZ, CONRADO JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:CONRADO
Middle Name:JOSE
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 1:5633 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 STE A
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-6192
Practice Address - Country:US
Practice Address - Phone:832-788-5092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIP8966207P00000X
TXBP10040275207Q00000X
TXP8966207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX760579756Medicaid