MEDICARE: JORDAN H. PERLOW M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VM0101X	Maternal & Fetal Medicine Physician	20808	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255390936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN H. PERLOW M.D.

Provider Business Mailing Address
First Line	:	901 E WILLETTA ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2727
Country	:	US
Telephone Number	:	602-239-2647
Fax Number	:	602-239-5295

Provider Business Practice Location Address
First Line	:	901 E WILLETTA ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2727
Country	:	US
Telephone Number	:	602-239-2647
Fax Number	:	602-239-5295

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	01/31/2012

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