Provider Demographics
NPI:1124225453
Name:ORDONEZ, CONRADO J (MD)
Entity Type:Individual
Prefix:
First Name:CONRADO
Middle Name:J
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
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-6191
Practice Address - Country:US
Practice Address - Phone:281-238-0443
Practice Address - Fax:281-238-0899
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7119207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130913005Medicaid
TX00547GMedicare PIN
TX130913005Medicaid