Healthcare Provider Details

I. General information

NPI: 1295398691
Provider Name (Legal Business Name): JORDAN ROBERT ALBRICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2019
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 NE 3RD AVE
CAMAS WA
98607-2408
US

IV. Provider business mailing address

462 1ST AVE STE 16N1
NEW YORK NY
10016-9196
US

V. Phone/Fax

Practice location:
  • Phone: 360-729-8234
  • Fax: 360-729-3337
Mailing address:
  • Phone: 212-562-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number338367
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61312052
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: