MEDICARE: JORDAN DEVELOPMENTAL PEDIATRICS PC

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	2080P0006X	Developmental - Behavioral Pediatrics Physician	26988	AZ

Other Identifiers

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

General Provider Information

NPI Number	:	1649229394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JORDAN DEVELOPMENTAL PEDIATRICS PC

Provider Business Mailing Address
First Line	:	21031 N CAVE CREEK RD
Second Line	:	STE F4
City	:	PHOENIX
State	:	AZ
Zip	:	85024-5525
Country	:	US
Telephone Number	:	602-956-3141
Fax Number	:	602-795-1671

Provider Business Practice Location Address
First Line	:	21031 N CAVE CREEK RD
Second Line	:	STE F4
City	:	PHOENIX
State	:	AZ
Zip	:	85024-5525
Country	:	US
Telephone Number	:	602-956-3141
Fax Number	:	602-795-1671

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TIMOTHY JORDAN
Credential	:	MD
Telephone Number	:	602-956-3141

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	04/18/2008

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