Healthcare Provider Details

I. General information

NPI: 1306898028
Provider Name (Legal Business Name): WILLIAM MCCALL JORDAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BILL JORDAN

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 S PAGOSA BLVD
PAGOSA SPRINGS CO
81147-8329
US

IV. Provider business mailing address

800 W MAGNOLIA AVE
FORT WORTH TX
76104-4611
US

V. Phone/Fax

Practice location:
  • Phone: 970-507-4000
  • Fax: 970-731-1988
Mailing address:
  • Phone: 817-759-7000
  • Fax: 817-759-7027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberE1345
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberDR.0043185
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberE1345
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: