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NPI Code Detail

MEDICARE: DOUGLAS A JORDAN JR. D.P.M.

MEDICARE: DOUGLAS A JORDAN JR. D.P.M.
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
1213E00000XPodiatristPO 2114FL
2213ES0103XFoot & Ankle Surgery PodiatristPO 2114FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3480018908OTHERFLRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1102751OTHERFLAVMED
210593101OTHERFLCITRUS GCMCI
465211OTHERFLBLUE CROSS BLUE SHIELD FLORIDA
5985373OTHERFLUNITED HEALTH CARE
601352OTHERFLUNIVERSAL HEALTH CARE
710593102OTHERFLCITRUS GCMCII
8MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
96200309OTHERFLGHI
10MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518945500
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOUGLAS A JORDAN JR. D.P.M.
Provider Business Mailing Address
First Line : 11528 US HIGHWAY 19
Second Line :
City : PORT RICHEY
State : FL
Zip : 34668-1442
Country : US
Telephone Number : 727-868-2151
Fax Number : 727-819-8362
Provider Business Practice Location Address
First Line : 11528 US HIGHWAY 19
Second Line :
City : PORT RICHEY
State : FL
Zip : 34668-1442
Country : US
Telephone Number : 727-868-2151
Fax Number : 727-868-7379
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2006
Last Update Date : 11/30/2009

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