MEDICARE: DR. DARIN JORDAN 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
1	207Q00000X	Family Medicine Physician	36100534	IL
2	207Q00000X	Family Medicine Physician	ME137712	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	821050	OTHER	IL	MEDICARE GROUP PTAN

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689625048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARIN JORDAN MD

Provider Business Mailing Address
First Line	:	133 BENMORE DR STE 200
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-4111
Country	:	US
Telephone Number	:	407-646-7070
Fax Number	:	407-646-7747

Provider Business Practice Location Address
First Line	:	133 BENMORE DR STE 200
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-4111
Country	:	US
Telephone Number	:	407-646-7070
Fax Number	:	407-646-7747

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	10/21/2019

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Directions to “ DR. DARIN JORDAN MD” Practice Location

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