Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 5687 | NV |
NPI | 1104913656 |
---|---|
Provider Name | Frank Thomas Jordan |
First Address | Las Vegas, NV 89128 |
Second Address | Las Vegas, NV 89128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 28/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002002576 | (05) | NV |
A77494 | (02) |