Healthcare Provider Details

I. General information

NPI: 1063875565
Provider Name (Legal Business Name): JORDAN DANE COLSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE
MIAMI FL
33136-1003
US

IV. Provider business mailing address

10 ARAGON AVE STE 1517
CORAL GABLES FL
33134-5329
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-8254
  • Fax:
Mailing address:
  • Phone: 618-841-8078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZM0300X
TaxonomyMedical Microbiology Physician
License NumberME152467
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: