MEDICARE: JORDAN WIEBE DO

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	2086S0122X	Plastic and Reconstructive Surgery Physician	80521	CT
2	390200000X	Student in an Organized Health Care Education/Training Program
3	2086S0122X	Plastic and Reconstructive Surgery Physician	012361	AZ

General Provider Information

NPI Number	:	1215590831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN WIEBE DO

Provider Business Mailing Address
First Line	:	2801 E CAMELBACK RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4363
Country	:	US
Telephone Number	:	480-680-9903
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 CEDAR ST BLDG 3
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06510-3218
Country	:	US
Telephone Number	:	203-785-2571
Fax Number	:

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

Provider Enumeration Date	:	04/18/2019
Last Update Date	:	06/21/2026

Similar Medicare Providers

1033117841 — RAFFAELLA MOROTTI MD
Practice Location Address:

310 CEDAR ST , PATHOLOGY DEPARTMENT
NEW HAVEN, CT
06510-3218

Practice Phone: 203-737-6325
Practice Fax:

1083603617 — JOSE COSTA MD
Practice Location Address:

310 CEDAR ST , LAUDER HALL ROOM 108
NEW HAVEN, CT
06510-3218

Practice Phone: 203-785-2788
Practice Fax:

1518956937 — JUNG H KIM MD
Practice Location Address:

310 CEDAR ST , LAUDER HALL RM 108
NEW HAVEN, CT
06510-3218

Practice Phone: 203-785-2788
Practice Fax:

1295716512 — JOHN H SINARD MD
Practice Location Address:

310 CEDAR ST , LAUDER HALL, ROOM 108
NEW HAVEN, CT
06510-3218

Practice Phone: 203-785-2788
Practice Fax: 203-737-5654

1154303402 — DAVID L RIMM MD
Practice Location Address:

310 CEDAR ST , LAUDER HALL, ROOM 108
NEW HAVEN, CT
06510-3218

Practice Phone: 203-785-3624
Practice Fax: 203-785-7037

1932180221 — MARIE EMMA ROBERT MD
Practice Location Address:

310 CEDAR ST , LAUDER HALL, ROOM 108
NEW HAVEN, CT
06510-3218

Practice Phone: 203-785-3624
Practice Fax: 203-785-7037

Directions to “ JORDAN WIEBE DO” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.