Healthcare Provider Details

I. General information

NPI: 1841286853
Provider Name (Legal Business Name): FRANK EDWIN JORDAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: F. E. JORDAN M.D.

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160C W UNIVERSITY PKWY
JACKSON TN
38305-1667
US

IV. Provider business mailing address

23 WINDWOOD DR
JACKSON TN
38305-8835
US

V. Phone/Fax

Practice location:
  • Phone: 731-660-5116
  • Fax: 731-554-0306
Mailing address:
  • Phone: 731-664-8126
  • Fax: 731-660-5119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD14614
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: