Healthcare Provider Details

I. General information

NPI: 1760943013
Provider Name (Legal Business Name): RONALD SCOTT JORDAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 N MCKENZIE ST
FOLEY AL
36535-2277
US

IV. Provider business mailing address

PO BOX 689022
FRANKLIN TN
37068-9022
US

V. Phone/Fax

Practice location:
  • Phone: 251-949-3842
  • Fax:
Mailing address:
  • Phone: 615-465-7390
  • Fax: 251-424-1131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2443
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2443
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: