Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 0101254956 | VA |
NPI | 1023371366 |
---|---|
Provider Name | Jordan T Ochsner |
First Address | Fort Stewart, GA 31314-5641 |
Second Address | Fort Stewart, GA 31314-5641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2012 |
Last Update Date | 18/09/2013 |