MEDICARE: JACK NORDEN M.D.

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	207QA0401X	Addiction Medicine (Family Medicine) Physician	ME20378	FL

General Provider Information

NPI Number	:	1831240696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACK NORDEN M.D.

Provider Business Mailing Address
First Line	:	1311 SW 4TH CT
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-7521
Country	:	US
Telephone Number	:	954-401-6426
Fax Number	:

Provider Business Practice Location Address
First Line	:	1311 SW 4TH CT
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-7521
Country	:	US
Telephone Number	:	954-401-6426
Fax Number	:

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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