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General NPI Number Information
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NPI Number | 1235286626
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Entity Type | Individual
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Provider Name | PETER MANNING JORDAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 09/03/2013
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Provider Practice Location Address
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Address Line | 1002 N CHURCH ST SUITE 103
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City | GREENSBORO
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State | NC
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Zip | 27401-1439
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Country | US
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Telephone | 336-272-6133
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 N ELM ST
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City | GREENSBORO
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State | NC
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Zip | 27401-1004
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Country | US
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Telephone | 336-832-7000
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Fax | 336-851-8427
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 30558
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License Number State | NC
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