Provider Demographics
NPI:1184094690
Name:JUAN C YORDAN MD PA
Entity type:Organization
Organization Name:JUAN C YORDAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:YORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-633-0473
Mailing Address - Street 1:PO BOX 3667
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34421-3667
Mailing Address - Country:US
Mailing Address - Phone:352-633-0473
Mailing Address - Fax:352-775-9562
Practice Address - Street 1:929 N US HIGHWAY 441 STE 102
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-3002
Practice Address - Country:US
Practice Address - Phone:352-633-0473
Practice Address - Fax:352-775-9562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98478261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care