Healthcare Provider Details

I. General information

NPI: 1609238716
Provider Name (Legal Business Name): JONATHAN DAIRE ORNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 TULANE AVE # SL50
NEW ORLEANS LA
70112-2632
US

IV. Provider business mailing address

1430 TULANE AVE # 8550
NEW ORLEANS LA
70112-2632
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-7809
  • Fax: 504-988-3971
Mailing address:
  • Phone: 504-988-1001
  • Fax: 504-988-1005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number312384
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: