Healthcare Provider Details

I. General information

NPI: 1235335472
Provider Name (Legal Business Name): CORINNE NICOLE JORDAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CORINNE NICOLE JEPPSON D.O.

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5206 RESEARCH DR
SAN ANTONIO TX
78240-5251
US

IV. Provider business mailing address

PO BOX 911230
DALLAS TX
75391-1230
US

V. Phone/Fax

Practice location:
  • Phone: 210-595-5300
  • Fax: 210-614-8740
Mailing address:
  • Phone: 972-997-8000
  • Fax: 972-234-2987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5101017162
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS11306
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberQ1836
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: