MEDICARE: DR. THOMAS EDISON JORDAN JR. M.D., M.P.H.

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	2084P0800X	Psychiatry Physician	ME59988	FL
2	2084P0800X	Psychiatry Physician	4301060662	MI
3	2084P0800X	Psychiatry Physician	52715	MA

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	:	1831192293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS EDISON JORDAN JR. M.D., M.P.H.

Provider Business Mailing Address
First Line	:	197 RIDGE RD
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33477-9660
Country	:	US
Telephone Number	:	561-339-7205
Fax Number	:	561-746-7297

Provider Business Practice Location Address
First Line	:	197 RIDGE RD
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33477-9660
Country	:	US
Telephone Number	:	561-339-7205
Fax Number	:	561-746-7297

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	01/16/2011

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