MEDICARE: JORDAN ASHLEY ESSENBURG

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	207QA0505X	Adult Medicine Physician	1059033	TX

General Provider Information

NPI Number	:	1164180477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN ASHLEY ESSENBURG

Provider Business Mailing Address
First Line	:	3435 DICKASON AVE APT 2319
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-4976
Country	:	US
Telephone Number	:	214-605-9679
Fax Number	:

Provider Business Practice Location Address
First Line	:	12201 MERIT DR STE 180
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-3124
Country	:	US
Telephone Number	:	972-385-9700
Fax Number	:

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

Provider Enumeration Date	:	12/03/2021
Last Update Date	:	12/03/2021

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Directions to “ JORDAN ASHLEY ESSENBURG ” Practice Location

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