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1205954955 NPI number — GARY JOSEPH ORDOG M.D.

NPI Number: 1205954955
Health Care Provider/Practitioner: GARY JOSEPH ORDOG M.D.

Information about “1205954955” NPI (GARY JOSEPH ORDOG M.D.) exists in 1205954955 in HTML format HTML  |  1205954955 in plain Text format TXT  |  1205954955 in PDF (Portable Document Format) PDF  |  1205954955 in an XML format XML  formats.

NPI Number : 1205954955 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1205954955",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ORDOG",
    "FirstName": "GARY",
    "MiddleName": "JOSEPH",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "23642 LYONS AVENUE",
    "SecondLineMailingAddress": "#220250",
    "MailingAddressCityName": "NEWHALL",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91322-0250",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "661-799-3453",
    "MailingAddressFaxNumber": "661-799-3453",
    "FirstLinePracticeLocationAddress": "23642 LYONS AVENUE",
    "SecondLinePracticeLocationAddress": "#220250",
    "PracticeLocationAddressCityName": "NEWHALL",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "91322-0250",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "661-799-3453",
    "PracticeLocationAddressFaxNumber": "661-799-3453",
    "EnumerationDate": "03/27/2007",
    "LastUpdateDate": "08/10/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207PT0002X",
          "TaxonomyName": "Medical Toxicology (Emergency Medicine) Physician",
          "LicenseNumber": "OG43038",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207PT0002X",
          "TaxonomyName": "Medical Toxicology (Emergency Medicine) Physician",
          "LicenseNumber": "G43038",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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