Provider Demographics
NPI:1093707341
Name:ORNATO, RICHARD D (PAC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:D
Last Name:ORNATO
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7152 COCA SABAL LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4263
Mailing Address - Country:US
Mailing Address - Phone:239-939-9939
Mailing Address - Fax:239-931-5060
Practice Address - Street 1:9400 GLADIOLUS DR
Practice Address - Street 2:SUITE 250
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-6699
Practice Address - Country:US
Practice Address - Phone:239-939-9939
Practice Address - Fax:239-931-5060
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101318363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00301180OtherRR MEDICARE
FL291197300Medicaid
FLY06C9OtherBCBS FL
FL291197300Medicaid
FLE4823WMedicare PIN