MEDICARE: JORDAN CAMERON DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	POD786	CO

General Provider Information

NPI Number	:	1578995809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN CAMERON DPM

Provider Business Mailing Address
First Line	:	1465 KELLY JOHNSON BLVD STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3945
Country	:	US
Telephone Number	:	719-488-4664
Fax Number	:	719-488-4667

Provider Business Practice Location Address
First Line	:	1465 KELLY JOHNSON BLVD STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3945
Country	:	US
Telephone Number	:	719-488-4664
Fax Number	:	719-488-4667

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

Provider Enumeration Date	:	08/09/2013
Last Update Date	:	05/09/2023

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Directions to “ JORDAN CAMERON DPM” Practice Location

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