MEDICARE: BARBARA JORDAN DO

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	207P00000X	Emergency Medicine Physician	34002925J	OH

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	:	1720049661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA JORDAN DO

Provider Business Mailing Address
First Line	:	9291 HIDDEN GLEN DR
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060
Country	:	US
Telephone Number	:	440-974-0557
Fax Number	:

Provider Business Practice Location Address
First Line	:	36000 EUCLID AVE
Second Line	:
City	:	WILLOUGHBY
State	:	OH
Zip	:	44094
Country	:	US
Telephone Number	:	440-953-6203
Fax Number	:	440-953-6202

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

Provider Enumeration Date	:	03/30/2006
Last Update Date	:	09/15/2011

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