Healthcare Provider Details

I. General information

NPI: 1871869990
Provider Name (Legal Business Name): JORDAN MICHAEL CHAISSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2012
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 AIRPORT BLVD STE D330
MOBILE AL
36608-6758
US

IV. Provider business mailing address

6701 AIRPORT BLVD STE D330
MOBILE AL
36608-6758
US

V. Phone/Fax

Practice location:
  • Phone: 251-607-9797
  • Fax:
Mailing address:
  • Phone: 251-607-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberPENDING
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberPENDING
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: