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NPI Code Detail

MEDICARE: JAMES RANDALL JORDAN MD

MEDICARE: JAMES RANDALL JORDAN MD
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
1207Y00000XOtolaryngology Physician17643MS

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00660862OTHERMEDICARE RAILROAD

Other Identifiers

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

General Provider Information

NPI Number : 1811968746
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES RANDALL JORDAN MD
Provider Business Mailing Address
First Line : 2500 N STATE ST
Second Line : DEPARTMENT OF OTOLARYNGOLOGY
City : JACKSON
State : MS
Zip : 39216-4500
Country : US
Telephone Number : 601-984-5160
Fax Number : 601-815-6985
Provider Business Practice Location Address
First Line : 2500 N STATE ST
Second Line : DEPARTMENT OF OTOLARYNGOLOGY
City : JACKSON
State : MS
Zip : 39216-4500
Country : US
Telephone Number : 601-984-5160
Fax Number : 601-815-6985
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2006
Last Update Date : 01/31/2013

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