Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 525 | SC |
N | 213ES0131X | Foot Surgery | 525 | SC |
NPI | 1295724839 |
---|---|
Provider Name | Dr. Michael J Jordan |
First Address | Spartanburg, SC 29306-3911 |
Second Address | Spartanburg, SC 29306-3911 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2005 |
Last Update Date | 29/10/2013 |