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NPI Code Detail

MEDICARE: AMY YOUNG JORDAN M.D.

MEDICARE: AMY YOUNG JORDAN M.D.
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
1207N00000XDermatology Physician200200555NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275502536
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY YOUNG JORDAN M.D.
Provider Business Mailing Address
First Line : 2704 SAINT JUDE ST
Second Line :
City : GREENSBORO
State : NC
Zip : 27405-3670
Country : US
Telephone Number : 336-954-7546
Fax Number : 336-235-4018
Provider Business Practice Location Address
First Line : 2704 SAINT JUDE ST
Second Line :
City : GREENSBORO
State : NC
Zip : 27405-3670
Country : US
Telephone Number : 336-954-7546
Fax Number : 336-235-4018
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2006
Last Update Date : 01/03/2014

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