Healthcare Provider Details

I. General information

NPI: 1497404859
Provider Name (Legal Business Name): BRIAN MATTHEW JORDAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 BELLEFONTAINE AVE STE 100
LIMA OH
45804-1868
US

IV. Provider business mailing address

1001 BELLEFONTAINE AVE
LIMA OH
45804-2800
US

V. Phone/Fax

Practice location:
  • Phone: 419-998-8234
  • Fax: 419-998-8233
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number34.018768
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: