Basic Information
| Provider Information | |||||||||
| NPI: | 1275502759 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | JORDAN | ||||||||
| FirstName: | MAUREEN | ||||||||
| MiddleName: | O | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9971 SAWLEAF CT | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809205501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1964844277 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6200 SW 73RD ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331434679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7866624000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 11/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 39496 | CO | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | MD.44292 | AL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 30243 | MS | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | ME157396 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 72632810 | 05 | CO | MEDICAID |