Healthcare Provider Details

I. General information

NPI: 1306466297
Provider Name (Legal Business Name): JORDAN DANIEL TAYLOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 GREENS DAIRY RD
RALEIGH NC
27616-4612
US

IV. Provider business mailing address

5220 GREENS DAIRY RD
RALEIGH NC
27616-4612
US

V. Phone/Fax

Practice location:
  • Phone: 919-781-1437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101284991
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2021-02551
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: