Provider Demographics
NPI:1598971723
Name:JORDAN, MICHAEL WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WAYNE
Last Name:JORDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 S MILL AVE
Mailing Address - Street 2:#605
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-3657
Mailing Address - Country:US
Mailing Address - Phone:480-433-1899
Mailing Address - Fax:
Practice Address - Street 1:3116 S MILL AVE
Practice Address - Street 2:#605
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-3657
Practice Address - Country:US
Practice Address - Phone:480-433-1899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2009-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA742272084P0800X
AZ296252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry