Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DS0000004461 | TN |
NPI | 1487725727 |
---|---|
Provider Name | Dr. Robert Dalson Jordan |
First Address | Knoxville, TN 37919-4939 |
Second Address | Knoxville, TN 37919-4939 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 08/07/2007 |