Healthcare Provider Details

I. General information

NPI: 1780049239
Provider Name (Legal Business Name): ELIZABETH JORDAN MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 EASTLAKE AVE E SUITE 120
SEATTLE WA
98102-3062
US

IV. Provider business mailing address

2825 EASTLAKE AVE E SUITE 120
SEATTLE WA
98102-3062
US

V. Phone/Fax

Practice location:
  • Phone: 206-637-9101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberMD60494572
License Number StateWA

VIII. Authorized Official

Name: ELIZABETH JORDAN
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 206-637-9101