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NPI Code Detail

MEDICARE: DAVID W JORDAHL MD

MEDICARE: DAVID W JORDAHL MD
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
1207Q00000XFamily Medicine PhysicianME113785FL
2207Q00000XFamily Medicine PhysicianDJ066423MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ME113785OTHERFLFLORIDA MEDICAL LICENSE

General Provider Information

NPI Number : 1376552489
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID W JORDAHL MD
Provider Business Mailing Address
First Line : 3051 KIESEL RD
Second Line :
City : BAY CITY
State : MI
Zip : 48706-2449
Country : US
Telephone Number : 989-778-2888
Fax Number : 989-778-2887
Provider Business Practice Location Address
First Line : 3051 KIESEL RD
Second Line :
City : BAY CITY
State : MI
Zip : 48706-2449
Country : US
Telephone Number : 989-778-2888
Fax Number : 989-778-2887
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2006
Last Update Date : 12/12/2018

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