Provider Demographics
NPI:1366635963
Name:ORDAL, ROGER E (CSA)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:E
Last Name:ORDAL
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:200 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1661
Mailing Address - Country:US
Mailing Address - Phone:270-326-6116
Mailing Address - Fax:270-326-6118
Practice Address - Street 1:200 CLINIC DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1661
Practice Address - Country:US
Practice Address - Phone:270-326-6116
Practice Address - Fax:270-326-6118
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYSA026363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical