Provider Demographics
NPI:1043241995
Name:SHELDON JORDAN, M.D., INC.
Entity Type:Organization
Organization Name:SHELDON JORDAN, M.D., INC.
Other - Org Name:SHELDON E. JORDAN, INC. A MEDICAL CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:INCORPORATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:E
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-829-5968
Mailing Address - Street 1:2811 WILSHIRE BLVD
Mailing Address - Street 2:# 790
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4803
Mailing Address - Country:US
Mailing Address - Phone:310-829-5968
Mailing Address - Fax:310-453-3685
Practice Address - Street 1:2811 WILSHIRE BLVD
Practice Address - Street 2:# 790
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4803
Practice Address - Country:US
Practice Address - Phone:310-829-5968
Practice Address - Fax:310-453-3685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38150208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91966Medicare UPIN
CAG38150Medicare ID - Type Unspecified