Provider Demographics
NPI:1801384615
Name:GRUSH, JORDAN ANTHONY (DO)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:ANTHONY
Last Name:GRUSH
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 1:901 RANCHO LN STE 135
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-3826
Mailing Address - Country:US
Mailing Address - Phone:702-383-7885
Mailing Address - Fax:
Practice Address - Street 1:901 RANCHO LN STE 135
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-3826
Practice Address - Country:US
Practice Address - Phone:702-383-7885
Practice Address - Fax:702-383-8235
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT1712207P00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine