Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | A171637 | CA |
N | 207ND0101X | MOHS-Micrographic Surgeon | A171637 | CA |
N | 207ND0900X | Dermatopathologist | A171637 | CA |
NPI | 1184087801 |
---|---|
Provider Name | Christian Jordan |
First Address | Rancho Mirage, CA 92270-4127 |
Second Address | Rancho Mirage, CA 92270-4127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2016 |
Last Update Date | 09/05/2021 |