Healthcare Provider Details

I. General information

NPI: 1487851820
Provider Name (Legal Business Name): NICHOLAS JOHN ORDYNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5475 S 500 E
OGDEN UT
84405-6905
US

IV. Provider business mailing address

5653 WOODLAND DR
MORGAN UT
84050-9914
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-2350
  • Fax: 801-479-2558
Mailing address:
  • Phone: 801-707-9093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number8294179-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: