Healthcare Provider Details

I. General information

NPI: 1831240696
Provider Name (Legal Business Name): JACK NORDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 SW 4TH CT
FORT LAUDERDALE FL
33312-7521
US

IV. Provider business mailing address

1311 SW 4TH CT
FORT LAUDERDALE FL
33312-7521
US

V. Phone/Fax

Practice location:
  • Phone: 954-401-6426
  • Fax:
Mailing address:
  • Phone: 954-401-6426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberME20378
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: