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NPI Code Detail

MEDICARE: JORDAN F FLEISHHACKER M.D.

MEDICARE: JORDAN F FLEISHHACKER 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
1208600000XSurgery Physician192315-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336172048
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN F FLEISHHACKER M.D.
Provider Business Mailing Address
First Line : 1650 COCHRANE CIR
Second Line : BLDG 7505, ROOM 163
City : FORT CARSON
State : CO
Zip : 80913-4604
Country : US
Telephone Number : 719-524-7355
Fax Number :
Provider Business Practice Location Address
First Line : 1650 COCHRANE CIR
Second Line : BLDG 7505, ROOM 163
City : FORT CARSON
State : CO
Zip : 80913-4604
Country : US
Telephone Number : 719-524-7355
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2006
Last Update Date : 05/13/2014

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