Provider Demographics
NPI:1093008237
Name:GLENN, JORDAN J (DO)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:J
Last Name:GLENN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:7727 W DEER VALLEY RD STE 220
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2121
Mailing Address - Country:US
Mailing Address - Phone:602-843-8317
Mailing Address - Fax:602-843-8317
Practice Address - Street 1:7727 W DEER VALLEY RD STE 220
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2121
Practice Address - Country:US
Practice Address - Phone:602-843-8317
Practice Address - Fax:602-843-9091
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-20
Last Update Date:2025-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ0068902086S0129X, 208600000X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery