MEDICARE: DR. JORDAN LANE GUICE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	0101257728	VA
2	2086S0102X	Surgical Critical Care Physician	0101257728	VA
3	2086S0127X	Trauma Surgery Physician	0101257728	VA
4	2086S0102X	Surgical Critical Care Physician	ME154139	FL

General Provider Information

NPI Number	:	1033556543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORDAN LANE GUICE M.D.

Provider Business Mailing Address
First Line	:	LANDSTUHL REGIONAL MEDICAL CENTER
Second Line	:	UNIT 33100
City	:	APO
State	:	AE
Zip	:	09180
Country	:	DE
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	LANDSTUHL REGIONAL MEDICAL CENTER
Second Line	:	UNIT 33100
City	:	APO
State	:	AE
Zip	:	09810
Country	:	DE
Telephone Number	:	314-555-0000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2013
Last Update Date	:	08/08/2024

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