Healthcare Provider Details

I. General information

NPI: 1437854312
Provider Name (Legal Business Name): JORDAN TIMOTHY BUCKINGHAM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W RANCH VIEW DR STE 3000
ROCKLIN CA
95765-5397
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 916-409-1400
  • Fax: 916-409-1499
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A23311
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: