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General NPI Number Information
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NPI Number | 1306038625
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Entity Type | Organization
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Legal Business Name | WILLIAM P JORDAN MD FACS
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Dates
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Enumeration Date | 08/10/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 175 EAST BROWN STREET SUITE 107 BUILDING 1
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301
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Country | US
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Telephone | 570-421-8948
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Fax |
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Provider Business Mailing Address
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Address Line | 175 EAST BROWN STREET SUITE 107 BUILDING 1
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301
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Country | US
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Telephone | 570-421-8948
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Fax | 570-424-7370
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Authorized Official
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Title or Position | PHYSICIAN
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Name | WILLIAM PETER JORDAN
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Credential | MD
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Telephone | 570-421-8948
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD030238L
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License Number State | PA
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