Healthcare Provider Details

I. General information

NPI: 1114965738
Provider Name (Legal Business Name): ERNESTO A DIAZ-ORDAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 PARK CLUB LN SUITE 200
WILLIAMSVILLE NY
14221-5263
US

IV. Provider business mailing address

180 PARK CLUB LN SUITE 200
WILLIAMSVILLE NY
14221-5263
US

V. Phone/Fax

Practice location:
  • Phone: 716-634-7350
  • Fax: 716-634-7656
Mailing address:
  • Phone: 716-634-7350
  • Fax: 716-634-7656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number160661
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number160661
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: