Provider Demographics
NPI:1013086883
Name:JORDAN, ROBERT W (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:JORDAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1551 S RENAISSANCE TOWNE DR
Mailing Address - Street 2:#400
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010
Mailing Address - Country:US
Mailing Address - Phone:801-295-7200
Mailing Address - Fax:801-295-4930
Practice Address - Street 1:1551 S RENAISSANCE TOWNE DR
Practice Address - Street 2:#400
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010
Practice Address - Country:US
Practice Address - Phone:801-295-7200
Practice Address - Fax:801-295-4930
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
UT1660681205207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D07361Medicare UPIN