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NPI Code Detail

MEDICARE: JORDAN MICAH PHELPS DO

MEDICARE: JORDAN MICAH PHELPS 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
1207Q00000XFamily Medicine PhysicianOS19877FL

Other Identifiers

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

General Provider Information

NPI Number : 1861952376
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN MICAH PHELPS DO
Provider Business Mailing Address
First Line : 705 WELLS RD STE 300
Second Line :
City : ORANGE PARK
State : FL
Zip : 32073-2982
Country : US
Telephone Number : 904-282-6331
Fax Number : 904-619-1080
Provider Business Practice Location Address
First Line : 14011 BEACH BLVD STE 120
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32250-1695
Country : US
Telephone Number : 904-223-6400
Fax Number : 833-578-1820
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2019
Last Update Date : 05/30/2023

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Directions to “ JORDAN MICAH PHELPS DO” Practice Location

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