Healthcare Provider Details

I. General information

NPI: 1033109707
Provider Name (Legal Business Name): DAMON M JORDAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W FOREVERGREEN RD
NORTH LIBERTY IA
52317-9848
US

IV. Provider business mailing address

701 W FOREVERGREEN RD
NORTH LIBERTY IA
52317-9848
US

V. Phone/Fax

Practice location:
  • Phone: 319-356-2223
  • Fax: 319-353-6745
Mailing address:
  • Phone: 319-356-2223
  • Fax: 319-353-6745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number130316
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA458
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number130316
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: