Healthcare Provider Details

I. General information

NPI: 1316941305
Provider Name (Legal Business Name): SHELDON E JORDAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date: 03/21/2006
Reactivation Date: 03/28/2006

III. Provider practice location address

2811 WILSHIRE BLVD STE 790
SANTA MONICA CA
90403-4805
US

IV. Provider business mailing address

2811 WILSHIRE BLVD STE 790
SANTA MONICA CA
90403-4805
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-5968
  • Fax: 310-453-3685
Mailing address:
  • Phone: 310-829-5968
  • Fax: 310-453-3685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberG38150
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: