Healthcare Provider Details

I. General information

NPI: 1225264948
Provider Name (Legal Business Name): JORDAN MILLER CASE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WAKE FOREST BAPTIST HEALTH MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-8668
US

IV. Provider business mailing address

DEPARTMENT OF ORTHOPAEDIC SURGERY MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-1070
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-8200
  • Fax: 336-716-8018
Mailing address:
  • Phone: 336-716-8200
  • Fax: 336-716-8018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number2018-00089
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2018-00089
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: