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General NPI Number Information
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NPI Number | 1417048554
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Entity Type | Individual
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Provider Name | JACOB JORDAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 04/06/2017
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Provider Practice Location Address
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Address Line | 2335 TAMIAMI TRAIL N. SUITE 501
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City | NAPLES
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State | FL
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Zip | 34103-4456
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Country | US
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Telephone | 239-263-0011
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Fax | 239-430-7823
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Provider Business Mailing Address
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Address Line | 2234 COLONIAL BLVD. ATTN: MANAGED CARE DEPT.
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City | FORT MYERS
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State | FL
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Zip | 33907
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Country | US
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Telephone | 239-931-7342
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Fax | 239-931-7385
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME0047319
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License Number State | FL
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