Healthcare Provider Details

I. General information

NPI: 1134240625
Provider Name (Legal Business Name): JORDAN SETH WEINER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8952 E DESERT COVE AVE SUITE 205
SCOTTSDALE AZ
85260
US

IV. Provider business mailing address

9097 E DESERT COVE AVE SUITE 260
SCOTTSDALE AZ
85260
US

V. Phone/Fax

Practice location:
  • Phone: 480-273-8688
  • Fax: 480-273-8689
Mailing address:
  • Phone: 480-273-8688
  • Fax: 480-273-8689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number26108
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: