Healthcare Provider Details

I. General information

NPI: 1750332672
Provider Name (Legal Business Name): HOPE C JORDAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N IRONWOOD DR
SOUTH BEND IN
46615
US

IV. Provider business mailing address

3127 SEA LN
BREMEN IN
46506-9389
US

V. Phone/Fax

Practice location:
  • Phone: 574-287-6333
  • Fax: 574-287-5651
Mailing address:
  • Phone: 574-248-0365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02001289A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: