Healthcare Provider Details

I. General information

NPI: 1194354415
Provider Name (Legal Business Name): JORDAN RICHARDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14040 N NORTHSIGHT BLVD
SCOTTSDALE AZ
85260-3601
US

IV. Provider business mailing address

14040 N NORTHSIGHT BLVD
SCOTTSDALE AZ
85260-3601
US

V. Phone/Fax

Practice location:
  • Phone: 602-246-0608
  • Fax:
Mailing address:
  • Phone: 602-246-0608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number81048
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: