Individual
JORDAN DANIEL WILLOUGHBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3591 S MERCY RD STE 101, GILBERT, AZ 85297-1192
(866) 974-2673
(866) 939-2673
Mailing address
18444 N 25TH AVE STE 310, PHOENIX, AZ 85023-1266
(866) 974-2673
(866) 939-2673
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10230
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
204289
—
AZ
Enumeration date
08/16/2023
Last updated
08/11/2025
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