MEDICARE: JORDAN DONSON

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1043108061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN DONSON

Provider Business Mailing Address
First Line	:	4211 JASMINE LN
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-6812
Country	:	US
Telephone Number	:	817-559-1209
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 LONE STAR DR STE 4
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75212-6326
Country	:	US
Telephone Number	:	214-698-2299
Fax Number	:

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

Provider Enumeration Date	:	06/26/2025
Last Update Date	:	06/26/2025

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Directions to “ JORDAN DONSON ” Practice Location

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