Healthcare Provider Details

I. General information

NPI: 1033261557
Provider Name (Legal Business Name): JOSEPH DEDRICK JORDAN M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 N CAMPBELL AVE
TUCSON AZ
85719-4330
US

IV. Provider business mailing address

1501 N CAMPBELL AVE FL 6
TUCSON AZ
85724-0001
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-8888
  • Fax:
Mailing address:
  • Phone: 520-694-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number74570
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number74570
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number74570
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: