Provider Demographics
NPI:1346478583
Name:KATZ, JORDAN ALLEN (DPM)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ALLEN
Last Name:KATZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 NW 27TH ST STE 108
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1902
Mailing Address - Country:US
Mailing Address - Phone:305-442-1780
Mailing Address - Fax:786-662-3899
Practice Address - Street 1:475 BILTMORE WAY STE 108
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5724
Practice Address - Country:US
Practice Address - Phone:305-442-1780
Practice Address - Fax:305-442-9505
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006119213ES0103X
FLPO4530213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1346478583OtherMEDICARE UPIN
PA245362A8KOtherMEDICARE PTAN