Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DS018932L | PA |
Y | 213EG0000X | General Practice | DS018932L | PA |
NPI | 1003892647 |
---|---|
Provider Name | Dr. David L Jordan |
First Address | Pittsburgh, PA 15243-1919 |
Second Address | Butler, PA 16001-2601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2005 |
Last Update Date | 14/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101357876 | PROMISE # (01) | PA |
24471-1 | DBP PROVIDER ID (01) | PA |