Provider Demographics
NPI:1649288556
Name:JORDAN, TAMERA B (MD)
Entity type:Individual
Prefix:DR
First Name:TAMERA
Middle Name:B
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W MCDOWELL ROAD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003
Mailing Address - Country:US
Mailing Address - Phone:602-257-8070
Mailing Address - Fax:602-257-8029
Practice Address - Street 1:301 W MCDOWELL ROAD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006
Practice Address - Country:US
Practice Address - Phone:602-257-8070
Practice Address - Fax:602-257-8029
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34494208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5796874OtherCIGNA
AZ984155OtherAHCCCS