Healthcare Provider Details

I. General information

NPI: 1225191620
Provider Name (Legal Business Name): JORDAN C MESSLER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PINELLAS ST MS #47
CLEARWATER FL
33756-3804
US

IV. Provider business mailing address

PO BOX 403631
ATLANTA GA
30384-3631
US

V. Phone/Fax

Practice location:
  • Phone: 727-462-7908
  • Fax: 727-462-7904
Mailing address:
  • Phone: 727-462-7908
  • Fax: 727-462-7904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME91769
License Number StateFL

VIII. Authorized Official

Name: DR. JORDAN MESSLER
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 727-462-7908