Provider Demographics
NPI:1902085822
Name:JORDAN, SARA M (MD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:M
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SARA
Other - Middle Name:MURIEL
Other - Last Name:MELTZER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:2400 UNSER BLVD SE
Practice Address - Street 2:1ST FLOOR, TOWER 2
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4740
Practice Address - Country:US
Practice Address - Phone:505-559-6100
Practice Address - Fax:505-462-8792
Is Sole Proprietor?:No
Enumeration Date:2007-10-27
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2014-0034207VX0201X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM59081864Medicaid
NM383897YS5YMedicare PIN