Provider Demographics
NPI:1679537120
Name:JORDAN - MOREY, EDMUNDO J (MD)
Entity Type:Individual
Prefix:DR
First Name:EDMUNDO
Middle Name:J
Last Name:JORDAN - MOREY
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:PO BOX 11689
Mailing Address - Street 2:FERNANDEZ JUNCOS STA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-2789
Mailing Address - Country:US
Mailing Address - Phone:787-728-7083
Mailing Address - Fax:787-728-3366
Practice Address - Street 1:1814 AVE FERNANDEZ JUNCOS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-3001
Practice Address - Country:US
Practice Address - Phone:787-728-7083
Practice Address - Fax:787-728-3366
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13273207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI53500Medicare UPIN
PR24058Medicare PIN
PR0024058Medicare PIN