Individual
JACOB JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2335 TAMIAMI TRAIL N., SUITE 501, NAPLES, FL 34103-4456
(239) 263-0011
(239) 430-7823
Mailing address
2234 COLONIAL BLVD., ATTN: MANAGED CARE DEPT., FORT MYERS, FL 33907
(239) 931-7342
(239) 931-7385
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME0047319
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
057907600
—
FL
01
—
08461
BCBS
FL
01
—
201912
WELLCARE
FL
01
—
292168
AVMED
FL
01
—
5954082
AETNA
FL
01
—
P00877422
RR MEDICARE
FL
01
—
P305081
FREEDOM
FL
01
—
P953733
OPTIMUM
FL
01
—
QMP000005106623
MOLINA
FL
Enumeration date
09/27/2006
Last updated
04/06/2017
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