MEDICARE: DANA L. JORDAN 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	363A00000X	Physician Assistant	1500601	KS

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	:	1578566311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA L. JORDAN P.A.

Provider Business Mailing Address
First Line	:	425 HUNTON RD
Second Line	:
City	:	EL DORADO
State	:	KS
Zip	:	67042-3015
Country	:	US
Telephone Number	:	316-305-3379
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 HUNTON RD
Second Line	:
City	:	EL DORADO
State	:	KS
Zip	:	67042-3015
Country	:	US
Telephone Number	:	316-305-3379
Fax Number	:

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	05/29/2015

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Directions to “ DANA L. JORDAN P.A.” Practice Location

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