Healthcare Provider Details

I. General information

NPI: 1336409317
Provider Name (Legal Business Name): ROBYN JORDAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8024 GLENWOOD AVE STE 305
RALEIGH NC
27612-1952
US

IV. Provider business mailing address

8024 GLENWOOD AVE STE 305
RALEIGH NC
27612-1952
US

V. Phone/Fax

Practice location:
  • Phone: 919-205-9848
  • Fax:
Mailing address:
  • Phone: 919-205-9848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number201301686
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: