Healthcare Provider Details

I. General information

NPI: 1316683543
Provider Name (Legal Business Name): TAYLOR M JORDAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34515 9TH AVE S
FEDERAL WAY WA
98003-6761
US

IV. Provider business mailing address

34515 9TH AVE S
FEDERAL WAY WA
98003-6761
US

V. Phone/Fax

Practice location:
  • Phone: 253-733-3969
  • Fax: 253-838-6285
Mailing address:
  • Phone: 253-733-3969
  • Fax: 253-838-6285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD61664196
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: