Provider Demographics
NPI:1013089218
Name:SCALO, JORDAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:SCALO
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 1:6811 AUSTIN CENTER BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3157
Mailing Address - Country:US
Mailing Address - Phone:512-380-9200
Mailing Address - Fax:512-380-9201
Practice Address - Street 1:6811 AUSTIN CENTER BLVD STE 400
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3157
Practice Address - Country:US
Practice Address - Phone:512-380-9200
Practice Address - Fax:512-380-9201
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH734422080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153942103Medicaid
TXH73442Medicare UPIN