Provider Demographics
NPI:1952382723
Name:JORDAN, HAROLD RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:RICHARD
Last Name:JORDAN
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 1:50 MINORCA AVE APT 1604
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4570
Mailing Address - Country:US
Mailing Address - Phone:786-600-3025
Mailing Address - Fax:413-727-3340
Practice Address - Street 1:50 MINORCA AVE APT 1604
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4570
Practice Address - Country:US
Practice Address - Phone:786-600-3025
Practice Address - Fax:413-727-3340
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA605362084P0800X
FLME1414512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3189228Medicaid
403161OtherTUFTS
MA25635OtherHEALTH NEW ENGLAND
MA25635OtherHEALTH NEW ENGLAND
A2910801Medicare Oscar/Certification