Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 34004 | CA |
NPI | 1851804348 |
---|---|
Provider Name | Dr. Andrew Jordan |
First Address | San Francisco, CA 94132-2221 |
Second Address | San Francisco, CA 94109-2539 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2017 |
Last Update Date | 07/11/2017 |