Healthcare Provider Details

I. General information

NPI: 1962484477
Provider Name (Legal Business Name): JORDAN MUSSARY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9801 GLADES RD
BOCA RATON FL
33434-3918
US

IV. Provider business mailing address

9750 NW 33RD ST SUITE 101
CORAL SPRINGS FL
33065-4042
US

V. Phone/Fax

Practice location:
  • Phone: 561-487-9912
  • Fax: 561-487-5070
Mailing address:
  • Phone: 954-752-9220
  • Fax: 954-755-5025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME66777
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: