Provider Demographics
NPI:1578660239
Name:JORDAN, CINDY BARRON
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:BARRON
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:LOUISE-CLACE
Other - Last Name:BARRON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2185 WOODS CT
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-6660
Mailing Address - Country:US
Mailing Address - Phone:727-734-6932
Mailing Address - Fax:727-734-4516
Practice Address - Street 1:2185 WOODS CT
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-6660
Practice Address - Country:US
Practice Address - Phone:727-734-6932
Practice Address - Fax:727-734-4516
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47943208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
160043479OtherRR MEDICARE
FL94463OtherBLUE SHIELD
FL263069900Medicaid
FL94463Medicare ID - Type Unspecified
160043479OtherRR MEDICARE