Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | J9721 | TX |
N | 207YP0228X | Pediatric Otolaryngology | J9721 | TX |
N | 2086X0206X | Surgical Oncologist | J9721 | TX |
NPI | 1003808528 |
---|---|
Provider Name | Mrs. Jennifer Ann Jordan |
First Address | Dallas, TX 75218-3700 |
Second Address | Dallas, TX 75218-3700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 26/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G85046 | (02) | TX |