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General NPI Number Information
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NPI Number | 1104851096
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Entity Type | Individual
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Provider Name | RAYMOND F JORDAN DO
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Gender | Male
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 103 N MAIN ST
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City | LINDALE
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State | TX
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Zip | 75771-3115
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Country | US
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Telephone | 903-882-3194
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Fax | 903-882-7405
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Provider Business Mailing Address
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Address Line | 4002 TECHNOLOGY CTR
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City | LONGVIEW
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State | TX
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Zip | 75605-2697
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Country | US
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Telephone | 903-247-0484
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Fax | 903-247-0485
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | J0842
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License Number State | TX
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