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General NPI Number Information
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NPI Number | 1093803660
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Entity Type | Organization
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Legal Business Name | E L JORDAN JR DO PC
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 01/10/2013
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Provider Practice Location Address
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Address Line | 2630 CUNNINGHAM AVE
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City | JOPLIN
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State | MO
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Zip | 64804-1542
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Country | US
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Telephone | 417-781-0044
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Fax | 417-781-6331
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Provider Business Mailing Address
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Address Line | 2630 CUNNINGHAM AVE
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City | JOPLIN
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State | MO
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Zip | 64804-1542
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Country | US
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Telephone | 417-781-0044
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Fax | 417-781-6331
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Authorized Official
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Title or Position | PRESIDENT
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Name | EARL LAWRENCE JORDAN JR.
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Credential | DO
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Telephone | 417-781-0044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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