Healthcare Provider Details

I. General information

NPI: 1679312870
Provider Name (Legal Business Name): JORDAN GARDNER MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 COLE BLVD STE 121
GOLDEN CO
80401-3213
US

IV. Provider business mailing address

1726 COLE BLVD STE 121
GOLDEN CO
80401-3213
US

V. Phone/Fax

Practice location:
  • Phone: 720-213-6109
  • Fax: 720-710-1310
Mailing address:
  • Phone: 720-258-6790
  • Fax: 720-710-1310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JORDAN GARDNER
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 678-458-3563