Provider Demographics
NPI:1770877946
Name:JORDAN, IVET (MD)
Entity type:Individual
Prefix:DR
First Name:IVET
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:IVET
Other - Middle Name:
Other - Last Name:JORDAN CARVAJAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8600 NW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6202
Mailing Address - Country:US
Mailing Address - Phone:305-642-5366
Mailing Address - Fax:305-631-3803
Practice Address - Street 1:2020 W 64TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-2607
Practice Address - Country:US
Practice Address - Phone:305-642-5366
Practice Address - Fax:305-631-3828
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME118873207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program