Provider Demographics
NPI:1235179623
Name:ORDIWAY, LESTER CEYLON (MD)
Entity Type:Individual
Prefix:
First Name:LESTER
Middle Name:CEYLON
Last Name:ORDIWAY
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:PO BOX 18307
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33679-8307
Mailing Address - Country:US
Mailing Address - Phone:813-871-5151
Mailing Address - Fax:
Practice Address - Street 1:508 S HABANA AVE STE 210
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609
Practice Address - Country:US
Practice Address - Phone:813-871-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065242174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF71299Medicare UPIN
FL23663Medicare ID - Type UnspecifiedMEDICARE NUMBER