Healthcare Provider Details

I. General information

NPI: 1326045642
Provider Name (Legal Business Name): ARTHUR E JORDAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 GROVE RD
GREENVILLE SC
29605-4630
US

IV. Provider business mailing address

PO BOX 484
EASLEY SC
29641-0484
US

V. Phone/Fax

Practice location:
  • Phone: 864-404-3094
  • Fax: 864-242-6517
Mailing address:
  • Phone: 864-546-4497
  • Fax: 864-546-4506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number8003
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number8003
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: