Provider Demographics
NPI:1346731296
Name:GARD, JOURDAN BRADSHAW (DO)
Entity type:Individual
Prefix:
First Name:JOURDAN
Middle Name:BRADSHAW
Last Name:GARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2399 ELLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1048
Mailing Address - Country:US
Mailing Address - Phone:325-665-8380
Mailing Address - Fax:
Practice Address - Street 1:11012 E 13 MILE RD STE 112
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2546
Practice Address - Country:US
Practice Address - Phone:586-573-6880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-27
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101027918207XS0106X
MI5101023987207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery