MEDICARE: LYNN DARREL JORDAN M.D., P.A.

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	207V00000X	Obstetrics & Gynecology Physician	J8615	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497851679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN DARREL JORDAN M.D., P.A.

Provider Business Mailing Address
First Line	:	7424 GREENVILLE AVE
Second Line	:	206
City	:	DALLAS
State	:	TX
Zip	:	75231-4552
Country	:	US
Telephone Number	:	214-373-1868
Fax Number	:	214-378-8365

Provider Business Practice Location Address
First Line	:	7424 GREENVILLE AVE
Second Line	:	206
City	:	DALLAS
State	:	TX
Zip	:	75231-4552
Country	:	US
Telephone Number	:	214-373-1868
Fax Number	:	214-378-8365

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	05/03/2013

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