Healthcare Provider Details

I. General information

NPI: 1548461080
Provider Name (Legal Business Name): AMANDA RENEE JORDAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA RENEE BRUGGMAN MD

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 HARRY HINES BLVD HOUSE STAFF & GME
DALLAS TX
75235-7708
US

IV. Provider business mailing address

8625 E VIA DE SERENO
SCOTTSDALE AZ
85258-3935
US

V. Phone/Fax

Practice location:
  • Phone: 214-590-8058
  • Fax:
Mailing address:
  • Phone: 214-558-3568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number51706
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberM7882
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number17539
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: