Provider Demographics
NPI:1245414523
Name:ORDONEZ & DOLAR MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:ORDONEZ & DOLAR MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUZVIMINDA
Authorized Official - Middle Name:BENATO
Authorized Official - Last Name:ORDONEZ DOLAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-215-0281
Mailing Address - Street 1:1109 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2430
Mailing Address - Country:US
Mailing Address - Phone:850-215-0821
Mailing Address - Fax:850-215-1904
Practice Address - Street 1:1109 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2430
Practice Address - Country:US
Practice Address - Phone:850-215-0821
Practice Address - Fax:850-215-1904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-22
Last Update Date:2007-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050580207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC45937Medicare UPIN
FL08447CMedicare PIN