Provider Demographics
NPI:1588711683
Name:JOURDAN, JEAN-BAPTISTE RAYMOND (MD)
Entity type:Individual
Prefix:
First Name:JEAN-BAPTISTE
Middle Name:RAYMOND
Last Name:JOURDAN
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 1:420 NE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-1140
Mailing Address - Country:US
Mailing Address - Phone:954-525-2003
Mailing Address - Fax:954-525-0212
Practice Address - Street 1:420 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-1140
Practice Address - Country:US
Practice Address - Phone:954-525-2003
Practice Address - Fax:954-525-0212
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 596212084P0800X
CAC537812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258565100Medicaid
FLB17106Medicare UPIN
FL258565100Medicaid