Provider Demographics
NPI:1114965738
Name:DIAZ-ORDAZ, ERNESTO A (MD)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:A
Last Name:DIAZ-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 1:180 PARK CLUB LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5263
Mailing Address - Country:US
Mailing Address - Phone:716-634-7350
Mailing Address - Fax:716-634-7656
Practice Address - Street 1:180 PARK CLUB LN
Practice Address - Street 2:SUITE 200
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5263
Practice Address - Country:US
Practice Address - Phone:716-634-7350
Practice Address - Fax:716-634-7656
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160661207Y00000X, 207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01442699Medicaid
NY00020006003OtherUNIVERA PROVIDER ID
NY1008002OtherIHA PROVIDER ID
NY000511816002OtherBCBS PROVIDER ID
NY00020006003OtherUNIVERA PROVIDER ID
NY000511816002OtherBCBS PROVIDER ID