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General NPI Number Information
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NPI Number | 1184094690
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Entity Type | Organization
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Legal Business Name | JUAN C YORDAN MD PA
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Dates
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Enumeration Date | 09/28/2015
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 929 N US HIGHWAY 441 STE 102
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City | LADY LAKE
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State | FL
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Zip | 32159-3002
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Country | US
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Telephone | 352-633-0473
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Fax | 352-775-9562
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Provider Business Mailing Address
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Address Line | PO BOX 3667
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City | BELLEVIEW
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State | FL
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Zip | 34421-3667
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Country | US
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Telephone | 352-633-0473
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Fax | 352-775-9562
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Authorized Official
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Title or Position | MD
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Name | JUAN CARLOS YORDAN
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Credential | MD
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Telephone | 352-633-0473
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME98478
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License Number State | FL
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