Provider Demographics
NPI:1871545301
Name:ORDINARIO, ERIC (DO)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:ORDINARIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 W US HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-4880
Mailing Address - Country:US
Mailing Address - Phone:386-752-4189
Mailing Address - Fax:386-752-4213
Practice Address - Street 1:4601 W US HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4880
Practice Address - Country:US
Practice Address - Phone:386-752-4189
Practice Address - Fax:386-752-4213
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7652208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256141700Medicaid
FL256141700Medicaid
FL56740Medicare ID - Type Unspecified