Provider Demographics
NPI:1528110947
Name:ISERMAN, JORDAN C (MD)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:C
Last Name:ISERMAN
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 1:900 GARDEN GATE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8629
Mailing Address - Country:US
Mailing Address - Phone:850-478-0008
Mailing Address - Fax:850-494-1817
Practice Address - Street 1:900 GARDEN GATE CIR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8629
Practice Address - Country:US
Practice Address - Phone:850-478-0008
Practice Address - Fax:850-494-1817
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME613082084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020746OtherVALUE OPTIONS
FL14886OtherBLUECROSSBLUE SHIELD
FL14886OtherBLUECROSSBLUE SHIELD
FL14886Medicare ID - Type UnspecifiedMEDICARE