Healthcare Provider Details

I. General information

NPI: 1912272543
Provider Name (Legal Business Name): JHONNY ERIK ORDONEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 N NOWELL ST
ORLANDO FL
32808-7539
US

IV. Provider business mailing address

6900 TAVISTOCK LAKES BLVD STE 300
ORLANDO FL
32827-7592
US

V. Phone/Fax

Practice location:
  • Phone: 407-290-9556
  • Fax: 407-290-9509
Mailing address:
  • Phone: 321-332-6947
  • Fax: 407-286-4515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License NumberME161448
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number06700926
License Number StateZZ
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME161448
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: