Provider Demographics
NPI:1205954955
Name:ORDOG, GARY JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:JOSEPH
Last Name:ORDOG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:23642 LYONS AVENUE
Mailing Address - Street 2:#220250
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91322-0250
Mailing Address - Country:US
Mailing Address - Phone:661-799-3453
Mailing Address - Fax:661-799-3453
Practice Address - Street 1:23642 LYONS AVENUE
Practice Address - Street 2:#220250
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91322-0250
Practice Address - Country:US
Practice Address - Phone:661-799-3453
Practice Address - Fax:661-799-3453
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2016-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAOG43038207PT0002X
CAG43038207PT0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical Toxicology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92385Medicare UPIN
CAG43038Medicare UPIN