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General NPI Number Information
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NPI Number | 1770824948
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Entity Type | Individual
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Provider Name | TIMOTHY MICHAEL JORDAN D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/12/2013
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 1551 W BAY DR STE 300
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City | LARGO
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State | FL
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Zip | 33770-2209
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Country | US
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Telephone | 727-581-3550
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Fax | 184-429-7880
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Provider Business Mailing Address
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Address Line | 1551 W BAY DR STE 300
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City | LARGO
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State | FL
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Zip | 33770-2209
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Country | US
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Telephone | 727-581-3350
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Fax | 727-586-6190
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | OS15966
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5101020439
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | OS15966
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License Number State | FL
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