Healthcare Provider Details

I. General information

NPI: 1104913656
Provider Name (Legal Business Name): FRANK THOMAS JORDAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 W CATHEDRAL ROCK DR STE #130
LAS VEGAS NV
89128
US

IV. Provider business mailing address

7200 W CATHEDRAL ROCK DR STE #130
LAS VEGAS NV
89128
US

V. Phone/Fax

Practice location:
  • Phone: 702-228-8600
  • Fax: 702-228-8689
Mailing address:
  • Phone: 702-228-8600
  • Fax: 702-228-8689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number5687
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: