MEDICARE: JOHN N JORDAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	13156	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DB4083	OTHER	SC	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1205824042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN N JORDAN MD

Provider Business Mailing Address
First Line	:	4728 JENN DR STE 104
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5714
Country	:	US
Telephone Number	:	843-449-2272
Fax Number	:	843-236-5088

Provider Business Practice Location Address
First Line	:	3816 HIGHWAY 17 S
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-5069
Country	:	US
Telephone Number	:	843-272-1411
Fax Number	:	843-272-2130

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	05/09/2019

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