Provider Demographics
NPI:1861734915
Name:VULCANO, JORDAN TAYLOR (DO)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:TAYLOR
Last Name:VULCANO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 S. CRISMON ROAD
Mailing Address - Street 2:SUITE 191
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209
Mailing Address - Country:US
Mailing Address - Phone:480-621-5891
Mailing Address - Fax:480-704-4019
Practice Address - Street 1:1801 S. CRISMON ROAD
Practice Address - Street 2:SUITE 191
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209
Practice Address - Country:US
Practice Address - Phone:480-621-5891
Practice Address - Fax:480-704-4019
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD01358731390200000X
AZ007950207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty