Provider Demographics
NPI:1770824948
Name:JORDAN, TIMOTHY MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:JORDAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 W BAY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2276
Mailing Address - Country:US
Mailing Address - Phone:727-490-2100
Mailing Address - Fax:855-222-3965
Practice Address - Street 1:1345 W BAY DR STE 101
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2276
Practice Address - Country:US
Practice Address - Phone:727-581-3550
Practice Address - Fax:184-429-7880
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS15966174400000X, 207RC0000X
MI5101020439207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine