Provider Demographics
NPI:1558504738
Name:JORDAN, JEFFREY MICHAEL (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:JORDAN
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Gender:M
Credentials:MD, PHD
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Mailing Address - Street 1:462 GRIDER ST
Mailing Address - Street 2:DK MILLER BUILDING
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3021
Mailing Address - Country:US
Mailing Address - Phone:716-898-5186
Mailing Address - Fax:716-898-3194
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:DK MILLER BLDG.
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-5186
Practice Address - Fax:716-898-3194
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2014-07-18
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Provider Licenses
StateLicense IDTaxonomies
NY275518208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery