Elijah Jordan Jr., M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

47197 Issued in AZ

Practice address

7125 East Juan Sanchez Blvd
Aspc- Yuma Health Services
San Luis, AZ 85349

Phone

(928) 627-8871

NPI assigned

May 29, 2013

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1369785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369785600000",
    "number": "1932546108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7125 EAST JUAN SANCHEZ BLVD",
            "address_2": "ASPC- YUMA HEALTH SERVICES",
            "city": "SAN LUIS",
            "state": "AZ",
            "postal_code": "85349",
            "telephone_number": "928-627-8871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7125 EAST JUAN SANCHEZ BLVD",
            "address_2": "ASPC- YUMA HEALTH SERVICES",
            "city": "SAN LUIS",
            "state": "AZ",
            "postal_code": "85349",
            "telephone_number": "928-627-8871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "ELIJAH",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-05-29",
        "last_updated": "2013-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "AZ",
            "license": "47197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in San Luis, AZ
• Providers in San Luis, AZ by specialty
• General Practice Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.