=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649612599
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JORDAN F HEBERT D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2013
-----------------------------------------------------
Last Update Date | 11/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19 FRIENDSHIP ST UNIT 240
-----------------------------------------------------
City | NEWPORT
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02840-2200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-619-3930
-----------------------------------------------------
Fax | 401-619-3932
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 LASALLE SQUARE
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-444-3239
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | DO00985
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------