MEDICARE: JIZ ALPHONS MATHEW JORDAN PA-C

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	363AM0700X	Medical Physician Assistant	PA10860	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1136026	OTHER	TX	NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS

General Provider Information

NPI Number	:	1487103396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIZ ALPHONS MATHEW JORDAN PA-C

Provider Business Mailing Address
First Line	:	16651 SOUTHWEST FWY STE 100
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-2393
Country	:	US
Telephone Number	:	281-494-4900
Fax Number	:

Provider Business Practice Location Address
First Line	:	16651 SOUTHWEST FWY STE 100
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-2393
Country	:	US
Telephone Number	:	281-494-4900
Fax Number	:

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

Provider Enumeration Date	:	10/04/2016
Last Update Date	:	04/24/2025

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