Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | MD14915 | TN |
NPI | 1003865346 |
---|---|
Provider Name | Jorge Enrique Ordonez |
First Address | Talbott, TN 37877-8605 |
Second Address | Chattanooga, TN 37403-2800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 27/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00341382B | (05) | GA |
0152247 | BLUE CROSS BLUE SHIELD (01) | TN |
024611 | GEORGIA MEDICAL LICENSE (01) | GA |
14915 | MEDICAL LICENSE (01) | TN |
A02519962 | DEA (01) | TN |
A97970 | (02) | TN |