Healthcare Provider Details

I. General information

NPI: 1578744215
Provider Name (Legal Business Name): EDWARD F JORDAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2007
Last Update Date: 02/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 MAIN ST
OLEAN NY
14760-1514
US

IV. Provider business mailing address

516 MAIN ST
OLEAN NY
14760-1514
US

V. Phone/Fax

Practice location:
  • Phone: 716-372-7600
  • Fax: 716-372-9680
Mailing address:
  • Phone: 716-372-7600
  • Fax: 716-372-9680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number125792
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125792
License Number StateNY

VIII. Authorized Official

Name: MR. EDWARD F JORDAN
Title or Position: PRESIDENT
Credential: MD
Phone: 716-372-7600