Provider Demographics
NPI:1447209663
Name:JORDAN, PATRICK M (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:M
Last Name:JORDAN
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:PO BOX 3406
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-3406
Mailing Address - Country:US
Mailing Address - Phone:843-341-3232
Mailing Address - Fax:843-341-3234
Practice Address - Street 1:2 GREENWOOD DR
Practice Address - Street 2:SUITE C
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29928-4538
Practice Address - Country:US
Practice Address - Phone:843-341-3232
Practice Address - Fax:843-341-3234
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14780207P00000X, 207Q00000X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC147807Medicaid
SC147807Medicaid
SC147807Medicaid