Provider Demographics
NPI:1326302662
Name:ORNELAS, DEREK ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:ALLEN
Last Name:ORNELAS
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:107 ROYAL BIRKDALE DR STE D
Mailing Address - Street 2:
Mailing Address - City:COLUMBIANA
Mailing Address - State:OH
Mailing Address - Zip Code:44408-8493
Mailing Address - Country:US
Mailing Address - Phone:330-482-0937
Mailing Address - Fax:330-482-0941
Practice Address - Street 1:107 ROYAL BIRKDALE DR STE D
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:OH
Practice Address - Zip Code:44408-8493
Practice Address - Country:US
Practice Address - Phone:330-482-0937
Practice Address - Fax:330-482-0941
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301101170208600000X
OH35.131679208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery