Provider Demographics
NPI:1295724839
Name:JORDAN, MICHAEL J (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:JORDAN
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:1399 JOHN B WHITE SR BLVD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-3911
Mailing Address - Country:US
Mailing Address - Phone:864-595-9300
Mailing Address - Fax:864-595-9400
Practice Address - Street 1:1399 JOHN B WHITE SR BLVD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-3911
Practice Address - Country:US
Practice Address - Phone:864-595-9300
Practice Address - Fax:864-595-9400
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2013-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC525213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery