Healthcare Provider Details

I. General information

NPI: 1114288610
Provider Name (Legal Business Name): JORDAN TRAVIS TOZER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2012
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MARSHALL ST EM: EMERGENCY MEDICINE
RICHMOND VA
23298-5051
US

IV. Provider business mailing address

PO BOX 980401 EM: EMERGENCY MEDICINE
RICHMOND VA
23298-0401
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-4860
  • Fax: 804-828-4603
Mailing address:
  • Phone: 804-828-4860
  • Fax: 804-828-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101258167
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: