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General NPI Number Information
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NPI Number | 1609843994
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Entity Type | Individual
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Provider Name | MARTIN JOURDEN D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/05/2006
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Last Update Date | 08/15/2018
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Provider Practice Location Address
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Address Line | 50 MEDICAL PARK BLVD. SUITE A
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City | PETERSBURG
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State | VA
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Zip | 23805-9274
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Country | US
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Telephone | 804-732-1286
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 203
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City | PRINCE GEORGE
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State | VA
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Zip | 23875-0203
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Country | US
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Telephone | 804-541-6666
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Fax |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 102201039
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License Number State | VA
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