Healthcare Provider Details

I. General information

NPI: 1528110947
Provider Name (Legal Business Name): JORDAN C ISERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 GARDEN GATE CIR
PENSACOLA FL
32504-8629
US

IV. Provider business mailing address

900 GARDEN GATE CIRCLE
PENSACOLA FL
32504-8629
US

V. Phone/Fax

Practice location:
  • Phone: 850-478-0008
  • Fax: 850-494-1817
Mailing address:
  • Phone: 850-478-0008
  • Fax: 850-494-1817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberME61308
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: